Al-Bader A, Christenson J T, Simonet F, Abul H, Dashti H, Schmuziger M
Department of Pathology, Faculty of Medicine, Kuwait University.
Cardiovasc Surg. 1998 Aug;6(4):406-14. doi: 10.1016/s0967-2109(98)00022-2.
Oligo-elements such as zinc (Zn), selenium (Se) and copper (Cu) have a significant influence on the function of the immune system. Various immunological and inflammatory changes are known to occur in patients undergoing cardiopulmonary bypass. The aim of this study was to evaluate changes in serum oligo-elements levels during and following cardiopulmonary bypass. The serum levels of Zn, Se and Cu were determined in 67 consecutive patients, with coronary artery disease admitted for coronary artery bypass grafting. Blood samples for oligo-elements, analysis were withdrawn into metal-free tubes just prior to the start of cardiopulmonary bypass; at 30, 60 and 90 min into cardiopulmonary bypass; following weaning from cardiopulmonary bypass; 30 min after termination of cardiopulmonary bypass; at 24 h; and on the 5th postoperative day. Trace elements analyses were performed using atomic absorption spectrophotometry. Interleukin 6 and 8, as well as serum albumin, creatine phosphokinase, lactate dehydrogenase and creatine phosphokinase-MB fractions were also analyzed. The mean age was 63 +/- 9 years and 91% (61) were men. The mean preoperative left ventricular function was 52 +/- 12%, Canadian Cardiovascular Society (CCS) angina class was 3.7 +/- 0.5 and 30% (20) of the operations were re-do's. All patients had normothermic cardiopulmonary bypass. Mean cardiopulmonary bypass-time was 85 +/- 31 min. One patient was lost for the recovery sampling (hospital mortality, 1.5%). Nine patients had a postoperative cardiac index < 2.0 liter/min per m2, which required pharmacological support and additional intra-aortic balloon pump in two of them. Other postoperative complications were few. There was a rapid depletion of S-selenium and S-Zn levels, which were halved at 30 min after cardiopulmonary bypass and remained low throughout the study period. The Cu/Zn ratio increased significantly at the start of cardiopulmonary bypass, which indicated an inflammatory reaction and was not normalized until the 5th postoperative day. Length of ischemia time, presence of diabetes. hypertension and hyperlipidemia did not influence the results, while a prolonged cardiopulmonary bypass-time > 120 min resulted in a higher Cu/Zn ratio than observed for shorter cardiopulmonary bypass-times. This indicates a more profound inflammatory response. Inflammatory parameters responded in the same manner as described earlier by others. These data indicate that severe loss of various oligo elements occur in patients undergoing coronary artery bypass grafting and suggests that a supplementary administration of zinc and perhaps also selenium could be appropriate during cardiopulmonary bypass.
锌（Zn）、硒（Se）和铜（Cu）等微量元素对免疫系统功能有显著影响。已知接受体外循环的患者会出现各种免疫和炎症变化。本研究的目的是评估体外循环期间及之后血清微量元素水平的变化。对67例连续因冠状动脉疾病入院接受冠状动脉旁路移植术的患者测定了血清Zn、Se和Cu水平。在体外循环开始前，将用于微量元素分析的血样采集到无金属管中；在体外循环进行到30、60和90分钟时；体外循环撤机后；体外循环结束后30分钟；24小时时；以及术后第5天。使用原子吸收分光光度法进行微量元素分析。还分析了白细胞介素6和8，以及血清白蛋白、肌酸磷酸激酶、乳酸脱氢酶和肌酸磷酸激酶-MB同工酶。平均年龄为63±9岁，91%（61例）为男性。术前平均左心室功能为52±12%，加拿大心血管学会（CCS）心绞痛分级为3.7±0.5，30%（20例）的手术为再次手术。所有患者均进行常温体外循环。平均体外循环时间为85±31分钟。1例患者失访未能进行恢复采样（医院死亡率为1.5%）。9例患者术后心脏指数<2.0升/分钟·平方米，其中2例需要药物支持及主动脉内球囊反搏。其他术后并发症较少。血清硒和血清锌水平迅速下降，在体外循环后30分钟时减半，并在整个研究期间保持较低水平。体外循环开始时铜/锌比值显著升高，表明存在炎症反应，直到术后第5天才恢复正常。缺血时间、糖尿病、高血压和高脂血症的存在不影响结果，而体外循环时间延长>120分钟导致铜/锌比值高于体外循环时间较短者。这表明炎症反应更严重。炎症参数的反应与其他人先前描述的相同。这些数据表明，接受冠状动脉旁路移植术的患者会出现多种微量元素的严重流失，并提示在体外循环期间补充锌以及可能补充硒可能是合适之举。
