Cardiopulmonary bypass in man: Role of the intestine in a self-limiting inflammatory response with demonstrable bacterial translocation
Cardiopulmonary bypass in man: Role of the intestine in a self-limiting inflammatory response with demonstrable bacterial translocation
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DOI：
10.1016/s0003-4975(03)01520-0
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发表时间：
2004-02-01
影响因子：
4.6
通讯作者：
Silveri, NG
中科院分区：
文献类型：
--
作者：
Rossi, M;Sganga, G;Silveri, NG
背景心脏搭桥术引起全身炎症反应，在所有病例的1%至2%中，导致多器官功能障碍。本研究的目的是评估肠道在这种反应的发病机制和发展中的可能作用。一项开放性、前瞻性临床研究招募了11名计划接受择期冠状动脉旁路移植术的选定患者。分别进行胃张力测定、铬标记试验、双糖肠吸收试验、聚合酶链反应微生物DNA试验、细胞因子和转录因子（核因子κ B）活性测定。术后期间，胃pH值保持稳定（范围：7.2 - 7.3）。胃粘膜和动脉血之间的二氧化碳分压梯度显著增加（从1到23 mm Hg），在术后第6小时达到峰值。白细胞介素6显著高于基础水平，在心肺转流术后3小时达到峰值（96.3 vs 24 pg/mL）。核因子kappaB从未达到高于脂多糖刺激后观察到的水平。大肠杆菌易位记录在10例患者：8例从主动脉交叉钳拆除，2例从术后第一个小时。相对于基础值（6.4%），尿液收集显示在手术后的前24小时内放射性同位素排泄显著增加（39.1%），尽管与双糖试验无显著差异。获得的结果表明，胃肠道粘膜损伤，随后增加的渗透性，大肠杆菌菌血症，并在没有显着的大循环变化和术后并发症的自限性炎症反应的激活之间的相关性。(C)2004年由胸外科医师协会发布。
Background. Cardiopulmonary bypass provokes a systemic inflammatory reaction that, in 1% to 2% of all cases, leads to multiorgan disfunction. The aim of this study was to evaluate the possible role of the intestine in the pathogenesis and development of this reaction.Methods. Eleven selected patients scheduled for elective coronary artery bypass graft surgery were enrolled in a open, prospective clinical study. Gastric tonometry, chromium-labeled test and double sugar intestinal absorption tests, polymerase chain reaction microbial DNA test, and measurement of cytokines and transcriptional factor (nuclear factor kappaB) activation were performed.Results. During the postoperative period, gastric pH remained stable (range, 7.2 to 7.3). The partial pressure for carbon dioxide gradient between the gastric mucosa and arterial blood increased significantly (from 1 to 23 mm Hg), peaking in the sixth postoperative hour. Interleukin 6 increased significantly over basal levels, peaking 3 hours after cardiopulmonary bypass (96.3 versus 24 pg/mL). Nuclear factor kappaB never reached levels higher than those observed after lipopolysaccharide stimulation. Escherichia coli translocation was documented in 10 patients: in eight cases from removal of aortic cross-clamps and in two cases from the first postoperative hour. With respect to basal value (6.4%), the urine collection revealed a significant increase in excretion of the radioisotope during the first 24 hours after surgery (39.1%), although there were no significant variations with the double sugar test.Conclusions. The results obtained showed a correlation between the damage of the gastrointestinal mucosa, subsequent increased permeability, E coli bacteremia, and the activation of a self-limited inflammatory response in the absence of significant macrocirculatory changes and postoperative complications. (C) 2004 by The Society of Thoracic Surgeons.