Inflammatory reaction and capillary leak syndrome related to cardiopulmonary bypass in neonates undergoing cardiac operations.
Inflammatory reaction and capillary leak syndrome related to cardiopulmonary bypass in neonates undergoing cardiac operations.
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心脏手术新生儿与体外循环相关的炎症反应和毛细血管渗漏综合征。
DOI：
10.1016/s0022-5223(96)70053-3
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发表时间：
1996
期刊：
影响因子：
--
通讯作者：
G. von Bernuth
中科院分区：
文献类型：
--
作者：
M. Seghaye;R. Grabitz;J. Duchateau;Sabine Bussea;S. Däbritz;Dieter Koch;G. Alzen;H. Hörnchen;B. Messmer;G. von Bernuth
我们研究了24例新生儿(平均年龄6天)行单纯大动脉转位手术时与体外循环相关的炎症反应与术后毛细血管渗漏综合征的关系。测定体外循环前、中、后的补体蛋白、白细胞计数、肿瘤坏死因子-α和组胺水平。此外，在体外循环期间，通过测量相对分子质量在21,200到718,000之间的蛋白质的血浆浓度来评估蛋白质从血管内到血管外的移动。24例新生儿中有13例发生毛细血管渗漏综合征。有毛细血管渗漏综合征的新生儿C5a水平(C5a，3.0±0.6μg/L比0.9±0.2μg/L)(平均值±标准差)和白细胞计数(白细胞，17.9±2.1×10 3/ml比11.7±0.8×10 3/ml)均高于无毛细血管渗漏综合征组(P<0.0 5)，提示这些新生儿处于术前炎症状态。两组患者的术前临床和手术数据是相同的。体外循环前，所有患者的血清蛋白浓度相似。体外循环后10分钟，有毛细血管渗漏综合征患者的蛋白浓度明显低于无毛细血管渗漏综合征患者：白蛋白(19%±1.5%比30%±6%，P<0.001)、免疫球蛋白G(17%±1.5%比29%±5.5%，P<0.001)和α-2-巨球蛋白(15%±1.2%比25%±4%，P<0.05)。在体外循环期间，有毛细血管渗漏综合征的患者的白蛋白浓度显著低于无毛细血管渗漏综合征的患者，而红细胞压积在两组中相似。在体外循环期间，毛细血管渗漏综合征患者的补体蛋白C3和C4浓度也较低，但没有C1抑制物。两组患者的C3d/C3比值和C5a水平相似。相比之下，有毛细血管渗漏综合征的患者体外循环中组胺释放明显高于无毛细血管渗漏综合征的患者(725.2±396.7 pg/mlvs-54.1±58.4pg/ml，p<；0.05)。给予鱼精蛋白后，毛细血管渗漏综合征患者血清肿瘤坏死因子-α水平显著升高(38.1±10.0pg/mlvs 15.3±3.4pg/mlp<；0.05)。两组患者在体外循环期间和术后的白细胞计数相似。这项研究表明，在体外循环开始后10分钟，有术后毛细血管渗漏综合征临床体征的患者蛋白质渗漏增加。有毛细血管渗漏综合征的患者较无毛细血管渗漏综合征的患者有更明显的组胺释放和肿瘤坏死因子-α释放，提示体外循环相关炎症反应与围手术期毛细血管损伤有关。毛细血管渗漏综合征患者的术前炎症状态可能会增强体外循环的炎症反应。(美国心脏病学会杂志1996；112：687-97)
We studied the inflammatory reaction related to cardiopulmonary bypass in 24 neonates (median age 6 days) undergoing the arterial switch operation for simple transposition of the great arteries, with respect to the development of postoperative capillary leak syndrome. Complement proteins, leukocyte count, tumor necrosis factor-α, and histamine levels were determined before, during, and after cardiopulmonary bypass. Additionally, protein movement from the intravascular into the extravascular space during cardiopulmonary bypass was assessed by the measurement of plasma concentrations of proteins with molecular weights ranging from 21,200 to 718,000. Capillary leak syndrome developed in 13 of the 24 neonates. Patients with capillary leak syndrome, as compared with those without, had preoperatively higher C5a levels (C5a, 3.0 ± 0.6 μg/L vs 0.9 ± 0.2 μg/L) (mean ± standard error of the mean) ( p < 0.05) and higher leukocyte counts (leukocytes, 17.9 ± 2.1 × 103cells/ml versus 11.7 ± 0.8 × 103cells/ml) ( p < 0.05), suggesting in these neonates a preoperative inflammatory state. Preoperative clinical and operative data were identical in both patient groups. Before cardiopulmonary bypass, serum protein concentrations were similar in all patients. Ten minutes after institution of cardiopulmonary bypass, protein concentrations fell to significantly lower values in patients with capillary leak syndrome than in those without: albumin (19% ± 1.5% vs 30% ± 6% of the prebypass value, p < 0.05), immunoglobulin G (17% ± 1.5% vs 29% ± 5.5%, p < 0.001), and α2-macroglobulin (15% ± 1.2% vs 25% ± 4%, p < 0.02). During cardiopulmonary bypass, albumin concentrations remained significantly lower in patients with capillary leak syndrome than in those without, whereas hematocrit values were similar in both groups. During cardiopulmonary bypass, patients with capillary leak syndrome also had lower concentrations of complement proteins C3 and C4 but not C1 inhibitor. C3d/C3 ratio and C5a levels were similar in both patient groups. In contrast, histamine liberation during cardiopulmonary bypass was significantly more pronounced in patients with capillary leak syndrome than in those without (725.2 ± 396.7 pg/ml vs -54.1 ± 58.4 pg/ml, p < 0.05). Tumor necrosis factor-α levels after protamine administration were also significantly higher in patients with capillary leak syndrome (38.1 ± 10.0 pg/ml vs 15.3 ± 3.4 pg/ml, p < 0.05). Leukocyte count during and after cardiopulmonary bypass was similar in both patient groups. This study demonstrates increased protein leakage as early as 10 minutes after initiation of cardiopulmonary bypass in patients having clinical signs of postoperative capillary leak syndrome. Patients with capillary leak syndrome displayed more pronounced histamine liberation and tumor necrosis factor-α liberation than patients without capillary leak syndrome, suggesting a relationship between cardiopulmonary bypass–related inflammatory reaction and perioperative capillary damage. A preoperative inflammatory state in patients with capillary leak syndrome could have enhanced the inflammatory response to cardiopulmonary bypass. (J THORAC CARDIOVASC SURG 1996;112:687-97)
高血压犬体外循环期间血管外液体的摄取。
DOI：
10.1016/0003-4975(94)90216-x
发表时间：
1994
期刊：
The Annals of thoracic surgery
影响因子：
--
作者：
Wolfer,RS;Bishop,GG;Burdett,MG;Shigemi,K;Freeman,JP;Krasna,MJ;McLaughlin,JS;Brunner,MJ
通讯作者：
Brunner,MJ
体外循环期间诱导白细胞介素 8 表达。
影响因子：
37.8
作者：
Kalfin,RE;Engelman,RM;Rousou,JA;Flack3rd,JE;Deaton,DW;Kreutzer,DL;Das,DK
通讯作者：
Das,DK