Borowiec J W, Venge P, Henze A, Nilsson B, Stiernström H
Department of Cardiothoracic Surgery, University Hospital, Uppsala, Sweden.
Thorac Cardiovasc Surg. 1997 Dec;45(6):295-301. doi: 10.1055/s-2007-1013752.
Blood activation during extracorporeal circulation is associated with morbidity and mortality in cardiac surgery. This activation can be diminished by usage of heparin-coated circuits. Nitric oxide has also been reported to influence humoral and cellular components of blood. This study was performed to determine biomaterial-dependent part of blood activation.
Fresh, whole human blood mixed with Ringer's solution was circulated through a heart-lung machine for two and half hours. Five circuits were heparin-coated (group HC), whilst five other circuits were uncoated (group NC). During the last half hour NO was added to the oxygen/air mixture.
Blood activation was estimated by measuring following parameters: interluekin 6, complement activation products C3a and terminal complement complex, and oxygen free radicals (OFR) production capacity, which was determined using chemiluminescence enhanced by serum opsonized zymosan (SOZ) and phorbol myristate acetate (PMA). Granulocyte activation was measured as release of myeloperoxidase (MPO) and human neutrophil lipocalin (HNL).
OFR in granulocyte suspension stimulated by SOZ and PMA were significantly lower in the NC group, mostly later during ECC. Similarly, lower neutrophil and monocyte counts were observed in this group. NO increased superoxide production in the whole blood in heparin-coated circuits, but did not change OFR in isolated granulocytes. MPO was also affected by heparin-coating. NO supply seemed to increase release of MPO and HNL. It is concluded that heparin-coating contributed to reduction of biomaterial-dependent blood activation. An addition of NO at late stage of ECC tended to influence this activation.
体外循环期间的血液激活与心脏手术的发病率和死亡率相关。使用肝素涂层回路可减少这种激活。据报道，一氧化氮也会影响血液的体液和细胞成分。本研究旨在确定血液激活中生物材料依赖性部分。
将新鲜的全血与林格氏液混合，通过心肺机循环两个半小时。五个回路为肝素涂层（HC组），另外五个回路未涂层（NC组）。在最后半小时，将一氧化氮添加到氧气/空气混合物中。
通过测量以下参数评估血液激活：白细胞介素6、补体激活产物C3a和末端补体复合物，以及氧自由基（OFR）产生能力，后者使用血清调理酵母聚糖（SOZ）和佛波酯肉豆蔻酸酯（PMA）增强的化学发光法测定。粒细胞激活通过髓过氧化物酶（MPO）和人中性粒细胞脂质运载蛋白（HNL）的释放来测量。
在NC组中，由SOZ和PMA刺激的粒细胞悬液中的OFR显著较低，大多在体外循环后期。同样，该组中观察到较低的中性粒细胞和单核细胞计数。一氧化氮增加了肝素涂层回路中全血中超氧化物的产生，但未改变分离的粒细胞中的OFR。MPO也受到肝素涂层的影响。一氧化氮供应似乎增加了MPO和HNL的释放。结论是肝素涂层有助于减少生物材料依赖性血液激活。在体外循环后期添加一氧化氮倾向于影响这种激活。
