CIRCULATING ENDOTOXIN AND TUMOR-NECROSIS-FACTOR DURING PEDIATRIC CARDIAC-SURGERY
CIRCULATING ENDOTOXIN AND TUMOR-NECROSIS-FACTOR DURING PEDIATRIC CARDIAC-SURGERY
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DOI：
10.1097/00003246-199208000-00004
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发表时间：
1992-08-01
影响因子：
8.8
通讯作者：
KHAN, WN
中科院分区：
文献类型：
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作者：
CASEY, WF;HAUSER, GJ;KHAN, WN
目的：研究内毒素和肿瘤坏死因子-α (TNF) 在接受心脏直视手术的儿童围手术期释放到循环中的假设，并评估这些因素在术后发病率中的可能作用。设计：前瞻性研究。地点：儿童医院的手术室和 ICU。患者：连续 24 名接受心脏直视手术修复先天性心脏病的患者。方法：内毒素和在围手术期的预定时间点测量从患者抽取的血液样本中的 TNF 浓度。 还测量了给予患者的所有液体和药物的样本中的这些浓度。在整个围手术期测量临床变量，并每天计算儿童死亡风险评分。结果：所有术前对照样本的内毒素和 TNF 均为阴性。 24 名患者中有 21 名（88%）在手术期间或手术后的血液中检测到内毒素或 TNF。 24 名患者中有 16 名 (67%) 的血液中检测到内毒素（浓度范围为 0.32 至 438 pg/mL）。大多数内毒素呈阳性的样本是在体外循环期间取出的，并且与来自泵、心脏切开抽吸标本和自体输血的阳性样本相关。除一名患者外，所有患者的血培养结果均为细菌生长阴性。 24 名患者中有 9 名 (37%) 的血液中检测到 TNF（浓度范围为 3 至 132 U/mL）。与 TNF 阴性患者相比，TNF 阳性患者术后 20 小时平均中心静脉压显着降低 (p < .05)，术后平均心率更高。当分别将内毒素或 TNF 阳性组与内毒素或 TNF 阴性组进行比较时，未发现围手术期发病率和术中状况的其他指标存在差异。结论：内毒素和 TNF 在儿科心脏直视手术期间和术后释放到循环中。 TNF 释放可能与心脏直视手术后观察到的一些血流动力学变化有关。
Objectives: To study the hypothesis that endotoxin and tumor necrosis factor-alpha (TNF) are released into the circulation during the perioperative period in children undergoing open-heart surgery, and to assess the possible role of these factors in postoperative morbidity.Design: Prospective study.Setting: Operating room and ICU of a children's hospital.Patients: Twenty-four consecutive patients undergoing open-heart surgery for repair of congenital heart disease.Methods: Endotoxin and TNF concentrations were measured in blood samples with drawn from patients at predetermined time points in the perioperative period. These concentrations were also measured in samples from all fluids and drugs administered to patients. Clinical variables were measured throughout the perioperative period, and the Pediatric Risk of Mortality score was calculated daily.Results: All of the preoperative control samples were negative for endotoxin and TNF. Endotoxin or TNF was detected in the blood of 21 (88%) of 24 patients during or after surgery. Endotoxin (ranging in concentrations from 0.32 to 438 pg/mL) was detected in the blood of 16 (67%) of the 24 patients. The majority of the samples positive for endotoxin were withdrawn during cardiopulmonary bypass and were associated with positive samples from the pump, from cardiotomy suction specimens, and from autotransfused blood. Blood cultures of all patients, except one, were negative for bacterial growth. TNF (ranging in concentrations from 3 to 132 U/mL) was detected in the blood of nine (37%) of the 24 patients. Patients positive for TNF had significantly (p < .05) lower mean central venous pressures at 20 hrs after surgery and higher mean heart rates postoperatively compared with patients negative for TNF. No differences in other indicators of perioperative morbidity and intraoperative conditions were found, when the groups Positive for endotoxin or TNF were compared with the groups negative for endotoxin or TNF, respectively.Conclusions: Endotoxin and TNF are released into the circulation during and after pediatric open-heart surgery. TNF release may be related to some of the hemodynamic changes observed after open-heart surgery.