Borowiec J, Jaramillo A, Venge P, Nilsson L, Thelin S
Department of Cardiothoracic Surgery, University Hospital, Uppsala, Sweden.
Cardiovasc Surg. 1997 Dec;5(6):568-73. doi: 10.1016/s0967-2109(97)00084-7.
Heparin-coated circuits used during extracorporeal circulation reduce many postoperative complications occurring after heart surgery. Such complications are partly related to leukocyte activation with subsequent release of active substances, e.g. oxygen free radicals, myeloperoxidase and lactoferrin. This experiment was performed to elucidate a possible influence of heparin-coating on leukocytes. A 2-h-long simulated extracorporeal circulation was performed on two groups of five extracorporeal circulation circuits, primed with heparinized, fresh whole human blood and Ringer's solution. Heparin-coated circuits (HC group) were compared with uncoated circuits (NC group). Oxygen free radical production was estimated by determination of malonyldialdehyde in plasma and erythrocyte suspension. Granulocyte activation was measured in terms of myeloperoxidase and lactoferrin release. Time-related changes in leukocyte subset counts were analysed. Heparin-coating diminished myeloperoxidase and lactoferrin release. There were significant inter-group differences after 90 and 120 min of extracorporeal circulation for myeloperoxidase (101 (12) microg/l and 107(12) microg/l in the HC group versus 154(20) microg/l and 174(23) microg/l in the NC group), and after 120 min of extracorporeal circulation for lactoferrin (78(5) microg/l in the HC group versus 212(49) microg/l in the NC group). No significant changes of MDA concentration were observed in plasma or erythrocytes; however, a tendency towards lower MDA levels was seen after 90 and 120 min of extracorporeal circulation in the NC group. Neutrophil, monocyte and eosinophil numbers decreased significantly in the NC group but were unchanged in the HC group, as were lymphocyte counts. Heparin-coated extracorporeal circulation circuits significantly reduce granulocyte activation and better preserve the number of circulating neutrophils, eosinophils and monocytes, but do not change oxygen free radical production during simulated extracorporeal circulation.
体外循环期间使用的肝素涂层管道可减少心脏手术后出现的许多术后并发症。此类并发症部分与白细胞激活及随后活性物质（如氧自由基、髓过氧化物酶和乳铁蛋白）的释放有关。进行本实验以阐明肝素涂层对白细胞的可能影响。对两组各五个体外循环管道进行了时长2小时的模拟体外循环，管道分别用肝素化的新鲜全血和林格液预充。将肝素涂层管道组（HC组）与未涂层管道组（NC组）进行比较。通过测定血浆和红细胞悬液中的丙二醛来评估氧自由基的产生。根据髓过氧化物酶和乳铁蛋白的释放情况来测量粒细胞激活。分析白细胞亚群计数随时间的变化。肝素涂层减少了髓过氧化物酶和乳铁蛋白的释放。体外循环90分钟和120分钟后，髓过氧化物酶存在显著的组间差异（HC组分别为101（12）μg/l和107（12）μg/l，NC组分别为154（20）μg/l和174（23）μg/l），体外循环120分钟后，乳铁蛋白也存在显著组间差异（HC组为78（5）μg/l，NC组为212（49）μg/l）。血浆或红细胞中丙二醛浓度未观察到显著变化；然而，NC组在体外循环90分钟和120分钟后有丙二醛水平降低的趋势。NC组中性粒细胞、单核细胞和嗜酸性粒细胞数量显著减少，而HC组无变化，淋巴细胞计数也是如此。肝素涂层的体外循环管道可显著减少粒细胞激活，并更好地维持循环中的中性粒细胞、嗜酸性粒细胞和单核细胞数量，但在模拟体外循环期间不会改变氧自由基的产生。
