Schmidt H, Bendtzen K, Mortensen P E
Dept. of Anaesthesiology, Gentofte Hospital, Hellerup, Denmark.
Acta Anaesthesiol Scand. 1998 May;42(5):558-64. doi: 10.1111/j.1399-6576.1998.tb05166.x.
The inflammatory response in patients undergoing cardiac surgery with cardiopulmonary bypass is well known and increased levels of inflammatory cytokines have been shown. High levels of cytokines have been reported in blood drained from the surgical field. The present study aimed to elucidate whether autotransfusion of shed mediastinal blood in itself causes increased cytokine levels in coronary artery bypass graft (CABG) patients.
A prospective, randomized controlled study was performed in 23 patients having elective uncomplicated CABG. Autotransfusion of shed mediastinal blood was done every hour for 18 h in group I. In group II, the shed mediastinal blood was accumulated for 4 h in the cardiotomy reservoir and then autotransfused every hour for the next 14 h. Plasma levels of tumour necrosis factor-alpha (TNFalpha) and interleukin (IL)-1alpha, IL-1beta, IL-6 were measured. In vitro study of cytokine production was performed with or without stimulation (phytohaemagglutinin (PHA) and Escherichia coli (E. coli) lipopolysaccharide (LPS)).
We found high levels of IL-6 in the shed mediastinal blood. However, autotransfusion of shed mediastinal blood did not lead to increased level of cytokines (TNFalpha, IL-1alpha, IL-1beta and IL-6) in plasma in group I nor in group II. In vitro study showed activation of the leucocytes in the shed mediastinal blood with a significantly increased production of TNFalpha and IL-6 both in the stimulated and non-stimulated samples.
Shed mediastinal blood contains high levels of IL-6. However, autotransfusion of shed mediastinal does not cause measurable elevations in plasma levels of IL-6. In vitro study shows that autotransfusion activates leucocytes, which may enhance production of inflammatory cytokines.
体外循环心脏手术患者的炎症反应众所周知，且已显示炎症细胞因子水平升高。据报道，手术野引流血液中细胞因子水平较高。本研究旨在阐明冠状动脉搭桥术（CABG）患者自体回输纵隔引流血本身是否会导致细胞因子水平升高。
对23例行择期非复杂性CABG的患者进行了一项前瞻性随机对照研究。第一组每小时进行18小时的纵隔引流血自体回输。第二组中，纵隔引流血在心脏切开储血器中积聚4小时，然后在接下来的14小时内每小时进行自体回输。测量血浆中肿瘤坏死因子-α（TNFα）、白细胞介素（IL）-1α、IL-1β、IL-6的水平。在有或无刺激（植物血凝素（PHA）和大肠杆菌（E. coli）脂多糖（LPS））的情况下进行细胞因子产生的体外研究。
我们发现纵隔引流血中IL-6水平较高。然而，纵隔引流血的自体回输在第一组和第二组中均未导致血浆中细胞因子（TNFα、IL-1α、IL-1β和IL-6）水平升高。体外研究显示纵隔引流血中的白细胞被激活，在刺激和未刺激的样本中TNFα和IL-6的产生均显著增加。
纵隔引流血中含有高水平的IL-6。然而，纵隔引流血的自体回输不会导致血浆中IL-6水平出现可测量的升高。体外研究表明自体回输激活白细胞，这可能会增强炎症细胞因子的产生。
