Modulation of the inflammatory response to cardiopulmonary bypass by dopexamine and epidural anesthesia
Modulation of the inflammatory response to cardiopulmonary bypass by dopexamine and epidural anesthesia
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DOI：
10.1034/j.1399-6576.2002.461010.x
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发表时间：
2002-11-01
影响因子：
2.1
通讯作者：
Silomon, M
中科院分区：
文献类型：
--
作者：
Bach, F;Grundmann, U;Silomon, M
背景：心肺转流（CPB）会诱导全身炎症反应。肠粘膜屏障的微循环依赖性改变以及随后的内毒素移位是这种炎症反应的假定机制。本研究的目的是阐明是否有两种不同的方法来调节内脏灌注可能会影响全身炎症CPB。方法：我们检查了40例择期冠状动脉搭桥手术的前瞻性，随机研究。一组（DPX）在麻醉诱导后持续给予多帕沙明（1 mug.kg（-1）.min（-1）），直至CPB后18 h。对照组（CON）以时间匹配的方式接受等体积的NaCl 0.9%。在第三组（EPI）中，在整个研究期间连续硬膜外输注0.25%布比卡因[（身高（cm）-100）.10（-3）=ml.h（-1）]。结果：CPB后血清降钙素原（PCT）、肿瘤坏死因子-α（TNF-α）、可溶性TNF受体、可溶性人细胞间粘附分子-1（hsICAM- 1）、C反应蛋白（CRP）及白细胞计数均明显升高。DPX和EPI组在不同时间点PCT、TNF-α和白细胞计数的增加均显著减弱。然而，无论是内脏血流量，也不氧输送和消耗是不同的，当与CON-group.Conclusion相比：这些结果表明，机制以外的改善内脏血流量DPX和EPI治疗的抗炎作用。
Background: Cardiopulmonary bypass (CPB) induces a systemic inflammatory reaction. Microcirculation-dependent alteration of the gut mucosal barrier with subsequent translocation of endotoxins is a postulated mechanism for this inflammatory response. This study was designed to elucidate whether two different approaches to modulate splanchnic perfusion may influence systemic inflammation to CPB.Methods: We examined 40 patients scheduled for elective coronary bypass surgery in a prospective, randomized study. One group (DPX) received dopexamine (1 mug.kg(-1).min(-1)) continuously after induction of anesthesia until 18 h after CPB. The control group (CON) received equal volumes of NaCl 0.9% in a time-matched fashion. In a third group (EPI) a continuous epidural infusion of bupivacaine 0.25% [( body height (cm) - 100).10(-3)=ml.h(-1)] was administered for the whole study period. Procalcitonin (PCT), tumor necrosis factor (TNF-alpha), soluble TNF receptor, human soluble intercellular adhesion molecule- 1, C-reactive protein (CRP) and leukocyte count were measured as parameters of inflammation.Results: All parameters significantly increased following CPB. Increases of PCT, TNF-alpha and leukocyte count were significantly attenuated in the DPX and EPI groups at different time points. However, neither splanchnic blood flow nor oxygen delivery and consumption were different when compared with the CON-group.Conclusion: These results do suggest that mechanisms other than an improved splanchnic blood flow by DPX and EPI treatment have to be considered for the anti-inflammatory effects.