接受体外循环的成人炎症介质：离心泵与滚压泵的比较

Inflammatory mediators in adults undergoing cardiopulmonary bypass: comparison of centrifugal and roller pumps.

作者信息

Ashraf S, Butler J, Tian Y, Cowan D, Lintin S, Saunders N R, Watterson K G, Martin P G

机构信息

Cardiothoracic Department, Killingbeck Hospital, Leeds, United Kingdom.

出版信息

Ann Thorac Surg. 1998 Feb;65(2):480-4. doi: 10.1016/s0003-4975(97)01349-0.

DOI:10.1016/s0003-4975(97)01349-0

PMID:9485250

Abstract

BACKGROUND

The nonocclusive centrifugal pump is used for cardiopulmonary bypass (CPB) and mechanical cardiac assistance. This study examined its impact on proinflammatory cytokine release.

METHODS

Forty-one patients undergoing elective coronary artery bypass grafting were randomized prospectively to either a standard roller pump group (n = 21) or a centrifugal vortex pump group (n = 20) for CPB. The two groups were well matched in age, sex, severity of disease, and duration of CPB and aortic cross-clamping. Plasma levels of the cytokines tumor necrosis factor-alpha, interleukin-1beta, interleukin-6, and interleukin-8, as well as terminal complement, neutrophil counts, and leukocyte elastase, were analyzed before, during, and after CPB.

RESULTS

In both groups, traces of tumor necrosis factor-alpha were observed infrequently and interleukin-1beta was not detected. Plasma levels of interleukin-6 and interleukin-8 increased during and after CPB, reaching a peak at 2 hours after protamine administration in both groups before returning toward baseline at 24 hours. The release of interleukin-6 was significantly greater in the centrifugal group (p < 0.05), whereas the interleukin-8 concentration did not differ between the groups throughout the study period. Levels of terminal complement increased in both groups perioperatively, reaching a peak 30 minutes after protamine administration, whereas neutrophil counts and elastase peaked 2 hours after protamine administration. Plasma terminal complement, neutrophil counts, and elastase release were significantly higher in the centrifugal group (p < 0.05). Peak terminal complement correlated (r = 0.64, p < 0.01) with peak elastase in the centrifugal group only.

CONCLUSIONS

This study confirms the proinflammatory nature of CPB in adults and demonstrates that use of the centrifugal pump induces a greater systemic inflammatory response than use of the standard roller pump.

摘要

背景

非阻塞性离心泵用于体外循环（CPB）和机械性心脏辅助。本研究检测了其对促炎细胞因子释放的影响。

方法

41例行择期冠状动脉旁路移植术的患者被前瞻性随机分为标准滚压泵组（n = 21）或离心泵组（n = 20）进行CPB。两组在年龄、性别、疾病严重程度、CPB持续时间和主动脉阻断时间方面匹配良好。在CPB前、期间和之后分析细胞因子肿瘤坏死因子-α、白细胞介素-1β、白细胞介素-6和白细胞介素-8的血浆水平，以及终末补体、中性粒细胞计数和白细胞弹性蛋白酶。

结果

在两组中，很少观察到肿瘤坏死因子-α的痕迹，未检测到白细胞介素-1β。两组中白细胞介素-6和白细胞介素-8的血浆水平在CPB期间和之后均升高，在两组中，在鱼精蛋白给药后2小时达到峰值，然后在24小时时恢复至基线。离心机组中白细胞介素-6的释放明显更高（p < 0.05），而在整个研究期间两组间白细胞介素-8浓度无差异。两组围手术期终末补体水平均升高，在鱼精蛋白给药后30分钟达到峰值时，而中性粒细胞计数和弹性蛋白酶在鱼精蛋白给药后2小时达到峰值。离心机组中的血浆终末补体、中性粒细胞计数和弹性蛋白酶释放明显更高（p < 0.05）。仅在离心机组中，终末补体峰值与弹性蛋白酶峰值相关（r = 0.64，p < 0.01）。