ARTERIAL AND VENOUS CYTOKINE RESPONSE TO CARDIOPULMONARY BYPASS FOR LOW-RISK CABG AND RELATION TO HEMODYNAMICS

被引：50

作者：

DENG, MC

WIEDNER, M

ERREN, M

MOLLHOFF, T

ASSMANN, G

SCHELD, HH

机构：

[1] Department of Thoracic and Cardiovascular Surgery, Westfalian Wilhelms-University, Münster

[2] Central Institute of Laboratory Medicine, Wesffalian Wilhelms-University, Münster

[3] Department of Anesthesiology and Surgical Intensive Care, Wesffalian Wilhelms-University, Münster

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 1995年 / 9卷 / 01期

关键词：

CYTOKINES; CARDIOVASCULAR PERFORMANCE; CARDIOPULMONARY BYPASS; CORONARY ARTERY BYPASS GRAFT; ARTERIOVENOUS CYTOKINE RELATIONSHIP;

D O I：

10.1016/S1010-7940(05)80044-2

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

During and after cardiopulmonary bypass (CPB), cytokines may affect cardiac performance and the immune response and are therefore of diagnostic and therapeutic interest. We have used EIA/EASIA kits to measure arterial and venous levels of interleukin-1-beta(IL-1-beta), IL-2, IL-2 receptor (IL-2-R), IL-6, tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma in 12 men and 3 women (mean age 59.4 +/- 8.5 years, mean left ventricular ejection fraction 66 +/- 11%, average of 2.5 +/- 0.64 vessels affected by disease) undergoing elective coronary artery bypass grafting (CABG). On average each patient received 3 +/- 0.85 bypass grafts and required a postoperative maximum dopamine-dose of 3.8 mug/kg per min. Mean CPB and operation times were 60 +/- 21 min, and 132 +/- 16 min, respectively. During CPB, the venous levels of IL-2 temporarily decreased from 234 to 0 (p<0.05) pg/ml and arterial and venous levels of IL-2-R temporarily decreased from 28 to 16, and 36 to 18 pM (p<0.05), respectively. After termination of CPB, there was an increase in the arterial and venous levels of IL-6 from below 3 to 253 and 277 pg/ml (p<0.05) and TNF-alpha from 1.1 to 5.7 and 0.7 to 4.0 pg/ml, respectively (p<0.05). Tumor necrosis factor-alpha-increases peaked 30 min, and IL-6 increases peaked 4 h after termination of CPB. Twenty-four hours after the end of CPB, IL-6 showed a tendency to return to baseline, but still remained significantly elevated. Tumor necrosis factor alpha returned to baseline. Interleukin-1-beta and IFN-gamma did not show significant elevations. Arterial and venous levels of IL-2, s-IL-2-R, IL-6, and TNF-alpha correlated closely (r = 0.83, r = 0.99, r = 0.99, and r = 0.92, respectively; p<0.001). Cardiac index at 5 min and 4 h after the termination of CPB was higher than after the induction of anesthesia (2.7 +/- 1.1 vs 4.4 +/- 1.0 and 4.3 +/- 0.7 1/min per m2, respectively; p<0.05), while systemic vascular resistance was lower 5 min and 4 h after the termination of CPB (1486 +/- 680 vs 698 +/- 269 and 707 +/- 200 dyn x sec x cm-5, respectively; p<0.05). Heart rate increased 5 min, 4 and 24 h after the termination of CPB (64 +/- 17.2 vs 93 +/- 14.7, 99 +/- 16.9, and 91 +/- 13.9, respectively; p<0.05). Pulmonary capillary wedge pressure increased 24 h after the termination of CPB (7 +/- 3.2 vs 14 +/- 5.1 mm Hg). A positive correlation was observed between IL-6 levels and heart rate (r = 0.49, p<0.05). No other correlations between cytokine levels and hemodynamic parameters were seen. In low risk patients on CPB for elective CABG, therefore, there appears to be a characteristic pattern of cytokine regulation, with a temporary decrease of IL-2 and IL-2-R during CPB and a temporary increase in IL-6 and TNF-alpha within 24 h after CPB. This pattern may contribute to the modulation of the immune response and cardiac performance in the perioperative period.

引用

页码：22 / 29

页数：8

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