THE ROLE OF DIFFERENT TYPES OF CORTICOSTEROIDS ON THE INFLAMMATORY MEDIATORS IN CARDIOPULMONARY BYPASS

被引：79

作者：

JANSEN, NJG ^{[1
]}

VANOEVEREN, W ^{[1
]}

VANVLIET, M ^{[1
]}

STOUTENBEEK, CP ^{[1
]}

EYSMAN, L ^{[1
]}

WILDEVUUR, CRH ^{[1
]}

机构：

[1] STATE UNIV GRONINGEN HOSP,DIV RES,DEPT CARDIO-PULM SURG,OOSTERSINGEL 59,9713 EZ GRONINGEN,NETHERLANDS

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 1991年 / 5卷 / 04期

关键词：

INFLAMMATORY REACTION; REPERFUSION; CORTICOSTEROIDS; CARDIOPULMONARY BYPASS;

D O I：

10.1016/1010-7940(91)90032-F

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

In a placebo-controlled double-blind study on patients undergoing cardiopulmonary bypass (CPB) we studied the inhibited effects of dexamethasone, a high dose of methylprednisolone, and a low dose of prednisolone on the inflammatory reaction induced by CPB. During CPB two episodes of blood activation were noticed. First, the blood-material interaction caused a significant increase in complement C3a and elastase concentrations after the start of bypass (p < 0.01). Secondly, the reperfusion of the ischemic heart, lungs, and peripheral tissue, after the release of the aortic cross-clamp, caused an additional increase in C3a and elastase concentration and a statistically significant increase in leukotriene B4 (LTB4) concentration and tissue plasminogen activator (t-PA) activity (p < 0.01, p < 0.05, respectively). Dexamethasone treatment effectively inhibited the increase in LTB4 concentration and t-PA activity after release of the cross-clamp (significant differences to the placebo group, p < 0.01, p < 0.05, respectively). High-dose methylprednisolone treatment was almost as effective as dexamethasone treatment, whereas low-dose prednisolone treatment was less effective that methylprednisolone in the inhibition of the inflammatory mediators (DM > MP > P). None of the corticosteroid regimens was able to inhibit the increase in complement C3a and elastase. We therefore conclude that corticosteroids do not have an effect on complement activation during CPB. However, leukocyte activation and t-PA activity after release of the aortic cross-clamp are effectively inhibited by corticosteroid treatment, in a dose-dependent way. The inhibition of this inflammatory reaction will have a favourable effect on the postoperative course in patients who have undergone CPB.

引用

页码：211 / 217

页数：7

共 34 条

[1]

Bone R.C., A controlled clinical trial of high dose methylpred- nisolone in the treatment of severe sepsis and septic shock, N Engl J Med, 317, pp. 653-658, (1987)

[2]

Cavarocchi N.C., Pluth J.R., Schaff H.V., Orszulak T.A., Hornburger H.A., Solis E., Kaye M.P., Clancy M.S., Kolff J., Deeb G.M., Complement activation during cardiopulmonary bypass. Comparison of bubble and membrane oxygenators, J Thorac Cardiovasc Surg, 91, pp. 252-258, (1986)

[3]

Chenoweth D.E., Cooper S.W., Hugh T.E., Stewart R.W., Blackstone E.H., Kirklin J.W., Complement activation during cardiopulmonary bypass, N Engl J Med, 304, pp. 497-503, (1981)

[4]

Coraim F.I., Laufer G., Ilias W., Wollenek G., Wolner E., Release of myocardial depressant factor during cardiopulmonary bypass Influence of corticosteroids (méthylprednisolone)and protease inhibitor (aprotinine), Proc Clin Biol Res, 236A, pp. 611-620, (1987)

[5]

Cwikel B.J., Barouski-Miller P.A., Coleman P.L., Gelehrter T.D., Dexamethasone induction of an inhibitor of plasminogen activator in HTC hepatoma cells, J Biol Chem, 259, pp. 6847-6851, (1984)

[6]

Emeis J.J., Brommer E.J.P., Kluft C., Brakman P., Progress in fibrinolysis, Churchill Livingstone Edinburgh, pp. 11-33, (1985)

[7]

Engler R.L., Schmid-Schonbein G.W., Pavelec R.S., Leukocyte capillary plugging in myocardial ischemia and perfusion in the dog, Am J Pathol, 111, pp. 98-111, (1983)

[8]

Ferries L.H., Marx J.J., Ray J., The effect of methyl- prednisolone on complement activation during cardiopulmonary bypass, J Extracorp Tech, 16, pp. 83-88, (1984)

[9]

Fleming J.S., Royston D., Westaby S., Desai J.B., Taylor K.M., Short communication: Neutrophil malondialdehyde content as an indicator of activation during cardiopulmonary bypass, Life Supp Systems, 4, pp. 257-261, (1986)

[10]

Fosse E., Mollnes T.E., Osterud A., Aasen A.O., Effects of méthylprednisoloneon complement activation and leukocyte counts during cardiopulmonary bypass, Scan J Cardiovasc Surg, 21, pp. 255-261, (1987)

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