In high-risk patients, combination of antiinflammatory procedures during cardiopulmonary bypass can reduce incidences of inflammation and oxidative stress
In high-risk patients, combination of antiinflammatory procedures during cardiopulmonary bypass can reduce incidences of inflammation and oxidative stress
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DOI：
10.1097/fjc.0b013e31802c0cd0
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发表时间：
2007-01-01
影响因子：
3
通讯作者：
Girard, Claude
中科院分区：
文献类型：
--
作者：
Goudeau, Jean-Jacques;Clermont, Gaelle;Girard, Claude
以往的研究表明，体外循环（CPB）与炎症反应的全面激活、氧自由基的产生和心肌损伤的迹象直接相关。因此，我们评估，在最弱的患者，生物学和临床效益的治疗优化的CPB通过几个cardiac procedures.High-risk患者接受心脏手术CPB下包括在这个前瞻性随机研究。对照组患者（n = 14）接受传统CPB，治疗组患者（n = 13）接受使用巴克斯特Duraflo II肝素涂层回路、高剂量抑肽酶和CPB前血液滤过的CPB。在术前、术中和术后第二天，测量患者的临床血流动力学和生物学指标、炎症和氧化应激标志物。自由基定量使用电子自旋共振光谱与自旋trap.显着较低浓度的C-反应蛋白，白细胞介素-6，肌酸激酶-MB，L-肌钙蛋白，乳酸和全身自由基中观察到的治疗患者的血浆。这些患者术后并发症和重症监护室的住院时间减少。因此，CPB前治疗优化可以减少炎症反应，降低氧化应激水平，有助于改善高危患者的临床结局。
Previous Studies showed that cardiopulmonary bypass (CPB) was directly associated with a global activation of the inflammatory response, production of oxygen free radicals, and signs of myocardial injury. We therefore evaluated, in the weakest patients, the biological and clinical benefits of a therapeutic optimization of CPB through the combination of several antiinflammatory procedures.High-risk patients undergoing cardiac Surgery under CPB were included in this prospective randomized Study. Control patients (n = 14) underwent conventional CPB, and treated patients (n = 13) underwent a CPB with Baxter Duraflo II heparin-coated circuits, high doses of aprotinin, and pre-CPB hemofiltration. Usual clinical hemodynamic and biological criteria, inflammation, and oxidative stress markers were measured before, during, and to the second postoperative day. Free radicals were quantified using electronic spin resonance spectroscopy with a spin trap.Significantly lower concentrations of C-reactive protein, interleukin-6, creatine kinase-MB, l-troponin, lactic acid, and systemic free radicals were observed in the plasma of treated patients. These patients had a reduction of postoperative complications and of the length of stay in the intensive care unit.Therefore, pre-CPB therapeutic optimization can reduce the inflammatory response, lower the level of oxidative stress, and help to ameliorate clinical outcome in high-risk patients.