ABSTRACT
BACKGROUND: Cardiopulmonary bypass is an essential process to maintain circulation for saving life during the cardiac surgery. But it is a process in which systemic inflammation was evoked inevitably because of the exposure of blood to foreign surface. The injuries to distal organs during the cardiopulmonary bypass were resulted from systemic inflammation and the disturbances of micro-circulations in the organs. We designed this study to research the effects of leukocyte depletion from pump-oxygenator priming solution on the systemic inflammation, and the micro-circulation of gastric mucosa that is suggested by the gastric mucosal CO2 partial pressure and acidity. MATERIAL AND METHOD: The dogs were divided into three groups according to the different pump-oxygenator priming solutions; non-hemic crystalloid solution; leukocyte-depleted homologous blood; and non leukocyte-depleted homologous blood. Each priming solution group contained five dogs. In all three groups, 2 hours of cardiopulmonary bypass, and 4 consecutive hours of general anesthesia was maintained on the mechanical ventilation. Each dog was evaluated for the gastric mucosal pH, CO2 partial pressure, arterial pH, CO2 partial pressure, the exhaled air CO2 partial pressure and the level of IL-8 on before the cardiopulmonary bypass, 1 hour after the cardiopulmonary bypass, 2 hours after the cardiopulmonary bypass, 2 hours after the restoration of normal circulation, and 4 hours after the restoration of normal circulation after the cardiopulmonary bypass. The levels of IL-8 were measured with ELISA (enzyme linked immunosorbent assay) technique. RESULT: 1. There were significant differences of gastric mucosal CO2 partial pressure between the leukocyte-depleted homologous blood group and other two groups(vs non leukocyte-depleted homologous blood group; p=0.02, vs non-hemic crystalloid solution group; p=0.01). 2. The gastric mucosal pH of leukocyte-depleted homologous blood group was significantly different from non leukocyte-depleted homologous blood group (p=0.01). 3. The levels of IL-8, which examine the systemic inflammation, showed significantly better results in leukocyte-depleted homologous blood group and non-hemic crystalloid solution group than non leukocyte-depleted homologous blood group (p=0.01, 0.01). CONCLUSION: Based upon these results, we concluded that the leukocyte depletion from the pump-oxygenator priming solution has a beneficial effects in reducing systemic inflammation and the preserving of gastric mucosal micro-circulation.
Subject(s)
Animals , Dogs , Anesthesia, General , Cardiopulmonary Bypass , Enzyme-Linked Immunosorbent Assay , Gastric Mucosa , Hydrogen-Ion Concentration , Inflammation , Interleukin-8 , Interleukins , Leukocytes , Partial Pressure , Respiration, Artificial , Systemic Inflammatory Response Syndrome , Thoracic SurgeryABSTRACT
A 55 year old male was admitted for dyspnea. The patient was diagnosed as acute myocardiac infarction, and coronary artery bypass grafting was performed with cardiopulmonary bypass. At postoperative day #1, Systemic Inflammatory Response Syndrome was developed with fever, leukocytosis, tachycardia, tachypnea and low systemic vascular resistance. The patient was recovered after being treated with high dose of (36 microgram/min) norepinephrine, and was discharged.
Subject(s)
Humans , Male , Middle Aged , Cardiopulmonary Bypass , Coronary Artery Bypass , Dyspnea , Fever , Heart , Infarction , Leukocytosis , Norepinephrine , Shock , Systemic Inflammatory Response Syndrome , Tachycardia , Tachypnea , Thoracic Surgery , Vascular ResistanceABSTRACT
A 55 year old male was admitted for dyspnea. The patient was diagnosed as acute myocardiac infarction, and coronary artery bypass grafting was performed with cardiopulmonary bypass. At postoperative day #1, Systemic Inflammatory Response Syndrome was developed with fever, leukocytosis, tachycardia, tachypnea and low systemic vascular resistance. The patient was recovered after being treated with high dose of (36 microgram/min) norepinephrine, and was discharged.
Subject(s)
Humans , Male , Middle Aged , Cardiopulmonary Bypass , Coronary Artery Bypass , Dyspnea , Fever , Heart , Infarction , Leukocytosis , Norepinephrine , Shock , Systemic Inflammatory Response Syndrome , Tachycardia , Tachypnea , Thoracic Surgery , Vascular ResistanceABSTRACT
0.05).After treatment for 7 days,TNF-a and IL-6 levels decreased in the medication groups(P
ABSTRACT
BACKGROUND: Hyperoxemic cardiopulmonary bypass (CPB) has been recognized as a safe technique and is widely used in cardiac surgery. However, hyperoxemic CPB may produce higher toxic oxygen species and cause more severe oxidative stress and ischemia/reperfusion injury than normoxemic CPB. This study was undertaken to compare inflammatory responses and myocardial injury between normoxemic and hyperoxemic CPB and to examine the beneficial effect of normoxemic CPB. MATERIAL AND METHOD: Thirty adult patients scheduled for elective cardiac surgery were randomly divided into normoxic group (n=15), who received normoxemic CPB (about PaO2 120 mmHg), and hyperoxic group (n=15), who received hyperoxemic CPB (about PaO2 400 mmHg). Myeloperoxidase (MPO), malondialdehyde (MDA), adenosine monophosphate (AMP), and troponin-T (TnT) concentrations in coronary sinus blood were determined at pre- and post-CPB. Total leukocyte and neutrophil counts in arterial blood were measured at the before, during, and after CPB. Lactate concentration in mixed venous blood was analyzed during CPB, and cardiac index (CI) and pulmonary vascular resistance (PVR) were evaluated pre- and post-CPB. All of the parameters were compared between the groups. RESULT: Normoxic group at post-CPB had lower MDA (4.79+/-0.7 vs 5.86+/-0.65 micromol/L, p=0.04) and MPO levels (5.38+/-1.01 vs 8.73+/-0.90 ng/mL, p=0.02), decreased total leukocyte counts (10,484+/-836 vs 13,572+/-1167/mm3, p=0.04) and higher AMP concentrations(1.23+/-0.07 vs 1.00+/-0.04 nmol/L, p=0.05), as well as a reduction in PVR (90.37+/-16.36 vs 118.12+/-12.21 dyne/sec/cm5, p=0.04) compared to hyperoxic group. There were no significant differences between the two groups with regard to TnT, lactate concentrations, and CI. CONCLUSION: Normoxic CPB provides less myocardial and lung damage related to oxygen free radicals and low inflammatory responses compared to hyperoxic CPB at post-CPB. Therefore, these results suggest that normoxemic CPB is a safe and salutary technique that could be applied in all cardiac surgery.