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[用于输液输血治疗的介质过滤作为预防使用人工血液循环的手术中全身炎症反应的一项措施]

[Filtration of media for infusion-transfusion therapy as a measure of prevention of systemic inflammatory reaction in surgery using artificial blood circulation].

作者信息

Kozlov I A, Shevchenko O P, Khubutiia M Sh, Kirov M Iu, Makarova L V, Chilikina G V, Sergeeva T A

出版信息

Anesteziol Reanimatol. 1997 May-Jun(3):21-6.

PMID:9289980
Abstract

Sixty-five coronary patients were subjected to aortocoronary bypass surgery. Three groups were distinguished: 1) controls-no filters; 2) patients in whom hemotransfusion (40 mu) and infusion filters were used during and on day 1 after surgery; and 3) in whom leukocyte filters for filtering residual perfusate from artificial circulation device were used in addition to the filters used in group 2. In the controls plasma level of leukocytic alpha-glycoprotein after artificial circulation increased 22 to 36 times, whereas in groups 2 and 3 it did not increase at all. After surgery the severity of leukocytosis, hyperthermia, and hyperenzymia assessed from the level of SGOT was reliably lower in patients in whom the filters were used. The time course of the oxygenation index (PaO2/FiO2) indicated an improvement of gas exchange due to filtration of infusion-transfusion media. The minimal values of PaO2/FiO2) and plasma content of C-reactive protein were observed in group 3. The mechanisms of systemic inflammatory reaction and organ dysfunction and some aspects of the protective effect of filters are discussed.

摘要

65名冠心病患者接受了主动脉冠状动脉搭桥手术。分为三组:1)对照组——不使用过滤器;2)手术期间及术后第1天使用输血(40毫升)和输液过滤器的患者;3)除第2组使用的过滤器外,还使用白细胞过滤器过滤人工循环装置中残留灌注液的患者。对照组人工循环后血浆白细胞α-糖蛋白水平增加22至36倍,而第2组和第3组则完全没有增加。使用过滤器的患者术后根据谷草转氨酶水平评估的白细胞增多、体温过高和酶血症的严重程度确实较低。氧合指数(PaO2/FiO2)的时间进程表明,由于输液输血介质的过滤,气体交换得到改善。第3组观察到PaO2/FiO2的最小值和C反应蛋白的血浆含量。讨论了全身炎症反应和器官功能障碍的机制以及过滤器保护作用的一些方面。

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