Oxidative stress precedes peak systemic inflammatory response in pediatric patients undergoing cardiopulmonary bypass operation
Oxidative stress precedes peak systemic inflammatory response in pediatric patients undergoing cardiopulmonary bypass operation
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DOI：
10.1016/j.freeradbiomed.2005.01.016
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发表时间：
2005-05-15
影响因子：
7.4
通讯作者：
Schmitt, B
中科院分区：
文献类型：
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作者：
Christen, S;Finckh, B;Schmitt, B
氧化应激似乎与体外循环(CPB)相关的术后并发症有关。儿科患者尤其容易出现这些并发症。考虑到这一点，我们检测了20名接受择期心脏手术的儿童在CPB停止前、期间和48小时后血浆中的氧化应激标志物，以及炎症参数和铁状态的全面分析。在主动脉阻断时(或4例部分体外循环患者关闭泵)，∼降低了抗坏血酸水平50%(P<；0.001)，并相应增加了脱氢抗坏血酸(P<；0.001，r=-0.80)和丙二醛(P<；0.001，r=-0.59)。与即刻氧化反应相反，IL-6和IL-8在CPB停止后3~12h才达到峰值。早期抗坏血酸丢失与体外循环时间(P<；0.002，r=0.72)、体外循环后血浆血红蛋白(P<；0.001，r=0.7)、体外循环后24和48小时的IL-6和IL-8水平(P<；0.001)相关，但与术后乳酸水平无关，提示早期氧化应激的主要原因是溶血，而不是炎症或缺血。呼吸机时间与早期抗坏血酸(P<；0.02，r=0.55)、血浆血红蛋白(P<；0.01，r=0.60)和丙二醛(P<；0.02，r=0.54)变化的相关性表明，溶血性氧化应激可能是CPB相关肺功能障碍的潜在原因。优化手术程序或减少溶血的治疗干预(如非体外循环手术)或由此产生的氧化应激(如抗氧化治疗)应被视为降低儿科CPB术后并发症发生率的可能策略。©2005 Elsevier Inc.保留所有权利。
Oxidative stress seems to contribute to cardiopulmonary bypass (CPB)-related postoperative complications. Pediatric patients are particularly prone to these complications. With this in mind, we measured oxidative stress markers in blood plasma of 20 children undergoing elective heart surgery before, during, and up to 48 h after cessation of CPB, along with inflammatory parameters and full analysis of iron status. Ascorbate levels were decreased by ∼ 50% (P < 0.001) at the time of aorta cross-clamp removal (or pump switch-off in 4 patients with partial CPB), and associated with corresponding increases in dehydroascorbate (P < 0.001, r = -0.80) and malondialdehyde (P < 0.01, r = -0.59). In contrast to the immediate oxidative response, peak levels of IL-6 and IL-8 were not observed until 3-12 h after CPB cessation. The early loss of ascorbate correlated with duration of CPB (P < 0.002, r = 0.72), plasma hemoglobin after cross-clamp removal (P < 0.001, r = 0.70), and IL-6 and IL-8 levels at 24 and 48 h after CPB (P < 0.01), but not with postoperative lactate levels, strongly suggesting that hemolysis, and not inflammation or ischernia, was the main cause of early oxidative stress. The correlation of ventilation time with early changes in ascorbate (P < 0.02, r = 0.55), plasma hemoglobin (P < 0.01, r = 0.60), and malondialdehyde (P < 0.02, r = 0.54) suggests that hemolysis-induced oxidative stress may be an underlying cause of CPB-associated pulmonary dysfunction. Optimization of surgical procedures or therapeutic intervention that minimize hemolysis (e.g., off-pump surgery) or the resultant oxidative stress (e.g., antioxidant treatment) should be considered as possible strategies to lower the rate of postoperative complications in pediatric CPB. © 2005 Elsevier Inc. All rights reserved.