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首页> 外文期刊>Journal of cardiac surgery. >Does the type of surgery effect systemic response following cardiopulmonary bypass?
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Does the type of surgery effect systemic response following cardiopulmonary bypass?

机译：手术类型会影响体外循环后的全身反应吗？

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BACKGROUND: Clinical studies conducted to elucidate the systemic response to cardiopulmonary bypass (CPB) did not differentiate possible effect of different types of cardiac surgical pathologies and operations on outcomes and have typically combined different procedures. We hypothesized that valve surgery induces more prominent systemic reaction compared to isolated on-pump CABG. METHODS: Twenty-seven patients undergoing primary on-pump CABG (Group 1, n = 14) or valve surgery with or without CABG (Group 2, n = 13) were prospectively enrolled. Heparin-bonded circuits were used in all patients. Cardiotomy suction was only used in Group 2. Clinical and laboratory markers were evaluated. RESULTS: Clinical measurements, including chest tube output, blood transfusion requirement, inotropic support requirement, and duration of ICU stay were not significantly different. Thrombin generation (PF-1.2) was significantly higher in Group 2 (p = 0.001). tPA was also significantly higher in Group 2 at 15 and 60 minutes on CPB (p < 0.01). Group 2 had significantly higher inflammatory response shown by elevation of IL6 (p = 0.005). Neuronal injury markers, S100beta and NSE, were significantly higher at the termination of CPB in Group 2 (p < 0.01). At no point of time course for any marker, Group 1 had significantly higher response compared to Group 2. CONCLUSIONS: Valve surgery induced more prominent systemic response than CABG. The possible explanations include the difference in baseline disease pathophysiology, and/or difference associated with the procedures such as open systems and use of cardiotomy suction. Future clinical studies assessing systemic response to CPB and therapies to blunt these need consider and account for these observed differences.
机译：背景：为阐明对体外循环（CPB）的全身反应而进行的临床研究并未区分不同类型的心脏手术病理学和手术对预后的可能影响，并且通常结合了不同的程序。我们假设与单纯的泵上CABG相比，瓣膜手术可引起更明显的全身反应。方法：前瞻性纳入了27例接受原位泵上CABG治疗的患者（第1组，n = 14）或接受或不进行CABG瓣膜手术的患者（第2组，n = 13）。所有患者均使用肝素结合回路。仅在第2组使用心脏切开吸引术。评估了临床和实验室指标。结果：临床测量，包括胸管输出量，输血量，正性肌力支持量和ICU停留时间无显着差异。第2组中的凝血酶生成（PF-1.2）显着更高（p = 0.001）。在CPB上第15和60分钟时，第2组的tPA也显着较高（p <0.01）。第2组的炎症反应明显高于IL6（p = 0.005）。在第2组CPB终止时，神经元损伤标志物S100beta和NSE明显更高（p <0.01）。在任何时间点上，任何标志物，第1组的反应均明显高于第2组。结论：瓣膜手术比CABG引起的全身反应更为显着。可能的解释包括基线疾病病理生理学的差异，和/或与诸如开放系统和心脏切开术的使用等程序相关的差异。未来的临床研究评估对CPB的全身反应和钝化这些疗法的需求，需要考虑并解释这些观察到的差异。

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