The effects of leucodepletion in patients who develop the systemic inflammatory response syndrome following cardiopulmonary bypass
The effects of leucodepletion in patients who develop the systemic inflammatory response syndrome following cardiopulmonary bypass
复制标题
DOI：
10.1177/026765910101600i110
复制
发表时间：
2001-03-01
期刊：
影响因子：
1.2
通讯作者：
Gant, V
中科院分区：
文献类型：
--
作者：
Treacher, DF;Sabbato, M;Gant, V
全身炎症反应综合征（SIRS）的发生与发病率和死亡率的增加有关。许多抗细胞因子试验未能证明任何结果的好处，并已在过去的20年中，这种情况的预后改善的证据很少。本研究检查了使用白色细胞过滤器去除心肺转流术（CPB）后36小时发生SIRS的患者中的多形核白细胞（PMN）的效果。24例患者随机接受白细胞滤过（LF）或对照治疗（CT）。两组在研究入组时在年龄、疾病严重程度和CPB时间长度方面匹配良好。LF患者使用静脉-静脉体外循环回路以200 ml/min的流速接受60 min的滤过期，每12 h重复一次循环，同时符合SIRS和其他入选标准。CT患者接受标准治疗，如果患者平均接受4.2个周期（范围1-8），并且在15分钟过滤后，总白细胞计数从16.2 +/- 5.3降至10.4 +/- 3.3 x 10（9）/l，PMN从14.4 +/- 5.2降至8.3 +/- 4.2 x 10（9）/l。平均血小板计数从127 +/- 87变为117 +/- 82 x 10（9）/l。未观察到与白细胞耗竭相关的不良反应。两组患者的死亡率、重症监护室的住院时间和出院时间均无差异。在研究期间定期评估器官功能，仅呼吸和肾功能发生显著变化。在LF患者中，与CT患者相比，通过低氧血症指数从基线的变化评估的呼吸功能和通过血清肌酐评估的肾功能显示出显著的治疗效果（p < 0.01，
The development of the systemic inflammatory response syndrome (SIRS) is associated with increased morbidity and mortality. Numerous anticytokine trials have failed to demonstrate any outcome benefit and there has been little evidence of improvement in the prognosis of this condition over the past 20 years. This study examines the effect of using a white cell filter designed to remove polymorphonuclear cells (PMNs) in patients who developed SIRS 36 h after cardiopulmonary bypass (CPB). Twenty-four patients were randomized to receive either leucofiltration (LF) or control therapy (CT). The two groups were well matched at study entry in terms of age, severity of illness and length of time on CPB. LF patients received 60 min filtration periods using a venovenous extracorporeal circuit at a flow rate of 200 ml/min with the cycle repeated every 12 h while SIRS and other entry criteria were met. CT patients received standard therapy, if patients received an average of 4.2 cycles (range 1-8) and, after 15 min filtration, the total leucocyte count had fallen from 16.2 +/- 5.3 to 10.4 +/- 3.3 x 10(9)/l and PMN from 14.4 +/- 5.2 to 8.3 +/- 4.2 x 10(9)/l. The mean platelet count changed from 127 +/- 87 to 117 +/- 82 x 10(9)/l. No adverse effects related to leucodepletion were observed. There was no difference between the groups in either mortality or length of stay at the intensive care unit or at hospital discharge. Organ function was assessed regularly during the study period and significant changes occurred only in respiratory and renal function. In the LF patients, respiratory function assessed by change in hypoxaemia index from baseline and renal function assessed by serum creatinine showed significant treatment effects compared to CT patients (p < 0.01,