The impact of heparin-coated cardiopulmonary bypass circuits on pulmonary function and the release of inflammatory mediators

被引:57
作者
de Vroege, R
van Oeveren, W
van Klarenbosch, J
Stooker, W
Huybregts, MAJM
Hack, CE
van Barneveld, L
Eijsman, L
Wildevuur, CRH
机构
[1] Vrije Univ Amsterdam, Med Ctr, Dept Extracorporeal Circulat, NL-1007 MB Amsterdam, Netherlands
[2] Vrije Univ Amsterdam, Med Ctr, Dept Anesthesiol, NL-1007 MB Amsterdam, Netherlands
[3] Vrije Univ Amsterdam, Med Ctr, Dept Cardiac Surg, NL-1007 MB Amsterdam, Netherlands
[4] Univ Groningen, Dept Biomat, NL-9700 AB Groningen, Netherlands
[5] Netherlands Red Cross, Blood Transfus Serv, Cent Lab, Amsterdam, Netherlands
关键词
D O I
暂无
中图分类号
R614 [麻醉学];
学科分类号
100217 [麻醉学];
摘要
Reduction of the inflammatory reaction with the use of heparin coating has been found during and after cardiopulmonary bypass (CPB). The question remains whether this reduced reaction also decreases the magnitude of CPB-induced pulmonary dysfunction. We therefore evaluated the effects of a heparin-coated circuit versus a similar uncoated circuit on pulmonary indices as well as on inflammatory markers of complement activation (C3b/c), elastase-alpha(1)-antitrypsin complex, and secretory phospholipase A, (sPLA,) during and after CPB. Fifty-one patients were randomly assigned into two groups undergoing coronary artery bypass grafting with either a heparin-coated (Group 1) or an uncoated (Group 2) circuit. During CPB, a continuous positive airway pressure of 5 cm H2O and a fraction of inspired oxygen (Fio(2)) of 0.21 were maintained. Differences in favor of the coated circuit were found in pulmonary shunt fraction (P < 0.05), pulmonary vascular resistance index (P < 0.05), and Pao(2)/Fio(2) ratio (P < 0.05) after CPB and in the intensive care unit. During and after CPB, the coated group demonstrated lower levels of sPLA(2). After CPB, C3b/c and the elastase-alantitrypsin complex were significantly less in the coated group (P < 0.001). The coated circuit was associated with a reduced inflammatory response, decreased pulmonary vascular resistance index and pulmonary shunt fraction, and increased Pao2/Fio2 ratio, suggesting that the coated circuit may have beneficial effects on pulmonary function. The correlation with sPLA2, leukocyte activation, and postoperative leukocyte count suggests reduced activation of pulmonary capillary endothelial cells.
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页码:1586 / 1594
页数:9
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