TIME-COURSE OF FREE-RADICAL ACTIVITY DURING CORONARY-ARTERY OPERATIONS WITH CARDIOPULMONARY BYPASS
TIME-COURSE OF FREE-RADICAL ACTIVITY DURING CORONARY-ARTERY OPERATIONS WITH CARDIOPULMONARY BYPASS
复制标题
DOI：
10.1016/s0022-5223(19)33769-9
复制
发表时间：
1993-06-01
影响因子：
6
通讯作者：
WALESBY, RK
中科院分区：
文献类型：
--
作者：
DAVIES, SW;DUFFY, JP;WALESBY, RK
体外循环后的心肌和肺损伤可能是由再灌流产生的氧自由基和中性粒细胞的激活引起的。用脂质过氧化(硫代巴比妥酸-活性物质)和磷脂-酯化双烯结合(18：2[9，11]/18：2[9，12]摩尔比)测定了25例冠状动脉手术患者的自由基活性。分别在缺血期前、缺血期及缺血后24小时采集动脉血样本。在缺血期内，自由基指标无明显变化，但在停止转流后，自由基指标显著升高。转流10分钟后，硫代巴比妥酸反应物质由96(中位数)上升至138(85~200)nmol/g白蛋白(P<；0.001)，摩尔比由2.23%(0.45%~7.70%)升至2.51%(0.39%~7.93%)(P<；0.02)。硫代巴比妥酸活性物质的值随后下降，但摩尔比在转流后4小时达到峰值，为2.64%(0.55%至10.08%)(p<；0.001)，此后回到基线水平。术后硫代巴比妥酸活性物质的增加与摩尔比相关(r=+0.53；p=0.006)。这些硫代巴比妥酸活性物质和摩尔比的增加与年龄、术前左心功能或移植血管的数量无关。硫代巴比妥酸活性物质的增加与体外循环时间相关(r=+0.43；p=0.03)。在使用鼓泡式氧合器进行体外循环的10名患者中，硫代巴比妥酸反应物质的增加明显大于使用膜式氧合器的15名患者(p<；0.02)。这些数据表明，在明显不复杂的冠状动脉搭桥术后，脂质过氧化和双烯结合增加，表明自由基活性增加。这一增加因患者而异，与患者或手术因素无关，但可能取决于体外循环期间使用的氧合器的类型。
Myocardial and pulmonary impairment after cardiopulmonary bypass may be caused by oxygen free radicals produced by reperfusion and by activated neutrophils. Free radical activity was assessed by assays for lipid peroxidation (thiobarbituric acid-reactive material) and phospholipid-esterified diene conjugation (18:2[9,11]/18:2[9,12] molar ratio) in 25 patients during coronary artery operations. Arterial blood samples were obtained before, during the ischemic period, and for 24 hours thereafter. There were no significant changes in free radical indices during the ischemic periods, but after cessation of bypass they increased significantly. Ten minutes after bypass thiobarbituric acid-reactive material rose from 96 (median; range 65 to 145) nmol/gm albumin to 138 (85 to 200) nmol/gm albumin (p < 0.001), and molar ratio rose from 2.23% (0.45% to 7.70%) to 2.51% (0.39% to 7.93%) (p < 0.02). Values of thiobarbituric acid-reactive material subsequently decreased, but molar ratio reached a peak at 4 hours after bypass, 2.64% (0.55% to 10.08%) (p < 0.001), thereafter returning to baseline. The postoperative increases in thiobarbituric acid-reactive material and in molar ratio were correlated (r = +0.53; p = 0.006). These increases in thiobarbituric acid-reactive material and in molar ratio were not related to age, preoperative left ventricular function, or the number of grafts performed. Increase in thiobarbituric acid-reactive material correlated with the duration of cardiopulmonary bypass (r = +0.43; p = 0.03). In 10 patients in whom cardiopulmonary bypass was performed using a bubble oxygenator, the increases in thiobarbituric acid-reactive material were significantly greater than in the 15 in whom a membrane oxygenator was used (p < 0.02). These data show that after apparently uncomplicated coronary operations with bypass there is an increase in lipid peroxidation and diene conjugation, indicating increased free radical activity. This increase varies between patients and does not relate to patient or surgical factors but may depend on the type of oxygenator employed during bypass.