CABG患者微创闭路体外循环与常规体外循环和体外循环技术的比较：凝血和炎性系统的选定参数。-小狗文献

【Comparison of minimally invasive closed circuit extracorporeal circulation with conventional cardiopulmonary bypass and with off-pump technique in CABG patients: selected parameters of coagulation and inflammatory system.].

【CABG患者微创闭路体外循环与常规体外循环和体外循环技术的比较：凝血和炎性系统的选定参数。】 复制标题 收藏收藏

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发表时间：2005-07-01
来源期刊：Eur J Cardiothorac Surg

DOI：10.1016/j.ejcts.2005.03.032 复制DOI
文章类型：杂志文章

作者列表：
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OBJECTIVE:Closed circuit extracorporeal circulation (CCECC) has been developed to reduce deleterious effects of standard cardiopulmonary bypass (CPB). This study compares the effects of CCECC (CORx system), CPB, and off-pump coronary artery bypass grafting (OPCAB) on red blood cell damage, coagulation activation, fibrinolysis and cytokine expression. METHODS:Thirty patients underwent coronary artery bypass grafting (CABG). Twenty of them were randomized into two groups: CCECC (n = 10), CPB (n = 10). While not randomized, OPCAB (n = 10) served as a separate reference group. CCECC and CPB patients received cardioplegic arrest. Interleukin 6 (IL-6), free hemoglobin (fHb), von Willebrand factor activity (vWf), thrombin-antithrombin-III-complex (TATc), prothrombin fragment 1.2 (F 1+2) and plasmin-antiplasmin complex (PAPc) were assessed preoperatively, perioperatively and 24 h postoperatively. RESULTS:CCECC showed significantly lower red blood cell damage than CPB (fHb: CCECC, 7.1+/- 5.7 micromol/l; CPB, 16.8+/-11.4 micromol/l; P = 0.025; OPCAB, 3.4+/-1.1 micromol/l). Perioperatively, CCECC exhibited significantly lower activation of coagulation and fibrinolysis than CPB, but did not differ from OPCAB (vWf: CCECC, 133+/-52%; CPB, 241+/-128%; P = 0.052; OPCAB, 153+/-58%; TATc: CCECC, 4.7+/-0.9 ng/ml; CPB, 31.1+/-15.8 ng/ml; P < 0.001; OPCAB, 2.4+/-0.6 ng/ml; PAPc: CCECC, 214+/-30 ng/ml; CPB, 897+/-367 ng/ml; P < 0.001; OPCAB, 253+/-98 ng/ml). In contrast, fibrinolysis markers and IL-6 were markedly increased in CCECC postoperatively (PAPc: CCECC, 458+/-98 ng/ml; CPB, 159+/-128 ng/ml; P < 0.001; OPCAB, 262+/-174 ng/ml; IL-6: CCECC, 123.4+/-49.8 pg/dl; CPB, 18.8+/-13.1 pg/dl; P < 0.001; OPCAB, 31.6+/-26.2 pg/dl). CONCLUSIONS:CCECC for CABG is associated with a significant reduction of red blood cell damage and activation of coagulation cascades similar to OPCAB when compared with conventional CPB while a delayed fibrinolytic and inflammatory activity was observed. These findings require further investigation to verify the promising concept of CCECC.

译文

目的：已经开发出闭路体外循环系统（CCECC），以减少标准体外循环（CPB）的有害作用。这项研究比较了CCECC（CORx系统），CPB和非体外循环冠状动脉搭桥术（OPCAB）对红细胞损伤，凝血激活，纤维蛋白溶解和细胞因子表达的影响。
方法：30例患者接受了冠状动脉搭桥术（CABG）。其中的20个被随机分为两组：CCECC（n = 10），CPB（n = 10）。虽然未随机分组，但OPCAB（n = 10）作为一个单独的参考组。 CCECC和CPB患者接受了心脏停搏。白细胞介素6（IL-6），游离血红蛋白（fHb），血管性血友病因子活性（vWf），凝血酶-抗凝血酶III复合物（TATc），凝血酶原片段1.2（F 1 2）和纤溶酶-抗纤溶酶复合物（PAPc）分别为在术前，围手术期和术后24小时进行评估。
结果：CCECC显示的红细胞损伤明显低于CPB（fHb：CCECC，7.1 /-5.7 micromol / l; CPB，16.8 /-11.4 micromol / l; P = 0.025; OPCAB，3.4 /-1.1 micromol / l）。围手术期，CCECC的凝血和纤溶活性明显低于CPB，但与OPCAB并无差异（vWf：CCECC，133 / -52％; CPB，241 / -128％; P = 0.052; OPCAB，153 / -58％ ; TATc：CCECC，4.7 /-0.9 ng / ml; CPB，31.1 /-15.8 ng / ml; P <0.001; OPCAB，2.4 /-0.6 ng / ml; PAPc：CCECC，214 / -30 ng / ml; CPB ，897 / -367ng / ml； P ＜0.001； OPCAB，253 / -98ng / ml）。相比之下，术后CCECC中的纤溶蛋白标记物和IL-6显着增加（PAPc：CCECC，458 / -98 ng / ml; CPB，159 / -128 ng / ml; P <0.001; OPCAB，262 / -174 ng / ml毫升； IL-6：CCECC，123.4 /-49.8 pg / dl； CPB，18.8 /-13.1 pg / dl； P <0.001； OPCAB，31.6 /-26.2 pg / dl）。
结论：与常规CPB相比，CAECC的CCECC与红细胞损伤的显着减少和类似于OPCAB的凝血级联的激活有关，同时观察到纤溶和炎症活性的延迟。这些发现需要进一步调查以验证CCECC的前景广阔。

【Comparison of minimally invasive closed circuit extracorporeal circulation with conventional cardiopulmonary bypass and with off-pump technique in CABG patients: selected parameters of coagulation and inflammatory system.].

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