Effect of cardiopulmonary bypass on postoperative bleeding and systemic inflammatory response

体外循环对术后出血及全身炎症反应的影响

• 批准号: 15591495
• 负责人: HASHIMOTO Kazuhiro
• 金额: $ 1.92万
• 依托单位: JIKEI UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2003
• 资助国家: 日本
• 起止时间: 2003 至 2004
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-15591495/
• 关键词: Cardiopulmonary bypass; Normothermia; Hypothermia; systemic inflammatory; Off-pump bypass; 術後出血; 線溶系亢進

Normothermic cardiopulmonary bypass(CPB) was beneficial in some instances for the prevention of bleeding after the open heart surgery, compared to hypothermic bypass. The heparin-coated circuit under the normothermic CPB suppressed subclinical plasma coagulation and fibrinolysis, and was effective for the prevention of platelet count and function. Addition of the aprotinin (100 million units) prime further preserved platelet function and offered the possibility of bringing about a further reduction in postoperative blood loss and blood requirements.Cardiac surgery with CPB has been considered the main causative markers of the proinflammatory responses. Patients were compared surrogate markers of inflammatory response in patients who underwent coronary bypass surgery with or without CPB. The significant elevation of elastase was observed in on-pump patients after the surgery ; however, other factors (complements, platelet activation, interleukin, elastase, and prostaglandin) were not different in the amount and course between the two groups. Regarding the aspect of systemic inflammatory response, the benefit of off-pump bypass was not demonstrated.

与低温体外循环相比，常温体外循环（CPB）在某些情况下有利于预防心脏直视手术后出血。常温CPB下的肝素涂层回路抑制亚临床血浆凝血和纤溶，并有效地预防血小板计数和功能。加入抑肽酶（1亿单位）预充进一步保护了血小板功能，并提供了进一步减少术后失血量和血液需求的可能性。比较了接受冠状动脉旁路手术（有或无CPB）患者的炎症反应替代标志物。术后在体外循环患者中观察到弹性蛋白酶显著升高;然而，两组之间的其他因素（补体、血小板活化、白细胞介素、弹性蛋白酶和前列腺素）在量和病程方面没有差异。关于全身炎症反应方面，非体外循环旁路的益处未得到证实。