Heparin-coated bypass circuits reduce pulmonary injury.
Heparin-coated bypass circuits reduce pulmonary injury.
复制标题
肝素涂层旁路回路可减少肺损伤。
DOI：
10.1016/0003-4975(93)90882-i
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发表时间：
1993
期刊：
影响因子：
--
通讯作者：
Baumgartner,WA
中科院分区：
文献类型：
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作者：
Redmond,JM;Gillinov,AM;Stuart,RS;Zehr,KJ;Winkelstein,JA;Herskowitz,A;Cameron,DE;Baumgartner,WA
体外循环回路的肝素涂层不仅减少了心脏手术期间的肝素需求，而且还可以减少与心肺转流（CPB）相关的器官损伤。为了检查这种可能性，在使用标准体外循环回路（S组，n = 6）或肝素涂层CPB回路（Carmeda生物活性表面）（HC组，n = 6）进行CPB的猪中研究了CPB后的肺损伤和中性粒细胞粘附分子表达。猪接受肝素钠（300 U/kg静脉注射），然后使用膜式氧合器进行90分钟的低氧（28 °C）CPB，随后观察2小时。采用免疫荧光流式细胞术检测外周血中性粒细胞数和中性粒细胞粘附分子亚单位CD 18的表达。体外循环后2 h，HC组动脉血氧分压较高（597.2 ± 31.2 vs 220.5 ± 42.3 mm Hg;p< 0.0001），这些动物的肺血管阻力较低（408.6 ± 69.4 vs. 1，159.8 ± 202.4 dyne · s · cm−5;p= 0.02），HC组的静态顺应性更高（66.4 ± 5.4 vs. 39.8 ± 5.8 mL/mm Hg;p= 0.004）。体外循环60分钟后，两组中性粒细胞粘附分子亚单位CD 18的表达增加相似，（S组和HC组分别为29.4% ± 19.5%和26.0% ± 24.4%）和中性粒细胞计数相似降低（S组和HC组分别为6，056 ± 1，285至2，453 ± 979个细胞/μL和6，010 ± 1，748至3，197 ± 1，225个细胞/μL）。本研究表明，肝素涂层可改善CPB后的肺功能，并且这种作用不是由改变的中性粒细胞动力学或粘附分子表达介导的。
Heparin coating of the extracorporeal circuit not only reduces heparin requirements during cardiac operations but also may reduce organ injury associated with cardiopulmonary bypass (CPB). To examine this possibility, pulmonary injury and neutrophil adhesion molecule expression after CPB were studied in pigs undergoing CPB with a standard extracorporeal circuit (group S, n = 6) or a heparin-coated CPB circuit (Carmeda BioActive Surface) (group HC, n = 6). Pigs received heparin sodium (300 U/kg intravenously) and then underwent 90 minutes of hypothermie (28 °C) CPB using membrane oxygenators, followed by 2 hours of observation. Blood samples were obtained for determination of neutrophil number and expression of the neutrophil adhesion molecule subunit CD18 (by immunofluorescence flow cytometry).The CPB-associated injury was less in group HC. Two hours after CPB, the arterial oxygen tension group was higher in group HC (597.2 ± 31.2 versus 220.5 ± 42.3 mm Hg;p< 0.0001), the pulmonary vascular resistance was lower in these animals (408.6 ± 69.4 versus 1,159.8 ± 202.4 dyne · s · cm−5;p= 0.02), and the static compliance was higher in group HC (66.4 ± 5.4 versus 39.8 ± 5.8 mL/mm Hg;p= 0.004). After 60 minutes of CPB, both groups had similar increases in expression of the neutrophil adhesion molecule subunit CD18 (29.4% ± 19.5% versus 26.0% ± 24.4%, group S and group HC, respectively) and similar decreases in neutrophil counts (6,056 ± 1,285 to 2,453 ± 979 cells/μL versus 6,010 ± 1,748 to 3,197 ± 1,225 cells/μL, group S and group HC, respectively). This study demonstrates that heparin coating improves pulmonary function after CPB and that this effect is not mediated by altered neutrophil kinetics or adhesion molecule expression.