PDF(Pubmed)
Abstract：
BACKGROUND: Extracorporeal circulation causes a systemic inflammatory response, that may cause postoperative haemodynamic instability and end-organ dysfunction. This study aimed to investigate the impact of minimal invasive extracorporeal circulation (MiECC) on the systemic inflammatory response compared with conventional extracorporeal circulation (CECC).
METHODS: Patients undergoing coronary artery bypass grafting were randomized to MiECC (n = 30) and CECC (n = 30). Primary endpoint was tumor necrosis factor-α. Secondary endpoints were other biochemical markers of inflammation (IL1β, IL6 and IL8, C-reactive protein, leukocytes), and markers of inadequate tissue perfusion and tissue damage (lactate dehydrogenase, lactate and creatine kinase-MB). In addition, we registered signs of systemic inflammatory response syndrome, haemodynamic instability, atrial fibrillation, respiratory dysfunction, and infection.
RESULTS: Patients treated with MiECC showed significantly lower levels of tumor necrosis factor-α than CECC during and early after extracorporeal circulation (median: MiECC 3.4 pg/mL; CI 2.2-4.5 vs. CECC 4.6 pg/mL; CI 3.4-5.6; p = 0.01). Lower levels of creatine kinase-MB and lactate dehydrogenase suggested less tissue damage. However, we detected no other significant differences in any other markers of inflammation, tissue damage or in any of the clinical outcomes.
CONCLUSIONS: Lower levels of TNF-α after MiECC compared with CECC may reflect reduced inflammatory response, although other biochemical markers of inflammation were comparable. Our results suggest better end-organ protection with MiECC compared with CECC. Clinical parameters related to systemic inflammatory response were comparable in this study.
BACKGROUND: NCT03216720.
METHODS: Patients undergoing coronary artery bypass grafting were randomized to MiECC (n = 30) and CECC (n = 30). Primary endpoint was tumor necrosis factor-α. Secondary endpoints were other biochemical markers of inflammation (IL1β, IL6 and IL8, C-reactive protein, leukocytes), and markers of inadequate tissue perfusion and tissue damage (lactate dehydrogenase, lactate and creatine kinase-MB). In addition, we registered signs of systemic inflammatory response syndrome, haemodynamic instability, atrial fibrillation, respiratory dysfunction, and infection.
RESULTS: Patients treated with MiECC showed significantly lower levels of tumor necrosis factor-α than CECC during and early after extracorporeal circulation (median: MiECC 3.4 pg/mL; CI 2.2-4.5 vs. CECC 4.6 pg/mL; CI 3.4-5.6; p = 0.01). Lower levels of creatine kinase-MB and lactate dehydrogenase suggested less tissue damage. However, we detected no other significant differences in any other markers of inflammation, tissue damage or in any of the clinical outcomes.
CONCLUSIONS: Lower levels of TNF-α after MiECC compared with CECC may reflect reduced inflammatory response, although other biochemical markers of inflammation were comparable. Our results suggest better end-organ protection with MiECC compared with CECC. Clinical parameters related to systemic inflammatory response were comparable in this study.
BACKGROUND: NCT03216720.
摘要：
背景：体外循环引起全身炎症反应，这可能导致术后血流动力学不稳定和终末器官功能障碍。本研究旨在探讨微创体外循环（MiECC）与常规体外循环（CECC）相比对全身炎症反应的影响。
方法：接受冠状动脉旁路移植术的患者随机分为MiECC（n=30）和CECC（n=30）。主要终点为肿瘤坏死因子-α。次要终点是炎症的其他生化标志物(IL1β，IL6和IL8，C反应蛋白，白细胞)，以及组织灌注不足和组织损伤的标志物(乳酸脱氢酶，乳酸和肌酸激酶-MB）。此外,我们记录了全身炎症反应综合征的迹象，血流动力学不稳定，心房颤动,呼吸功能障碍,和感染。
结果：接受MiECC治疗的患者在体外循环期间和体外循环后早期的肿瘤坏死因子-α水平明显低于CECC（中位数：MiECC3.4pg/mL；CI2.2-4.5vs.CECC4.6pg/mL；CI3.4-5.6；p=0.01）。较低水平的肌酸激酶-MB和乳酸脱氢酶表明组织损伤较小。然而,我们没有检测到其他炎症标志物的显著差异，组织损伤或任何临床结果。
结论：与CECC相比，MiECC后TNF-α水平降低可能反映了炎症反应降低，尽管其他炎症生化标志物具有可比性。我们的结果表明，与CECC相比，MiECC具有更好的末端器官保护作用。在这项研究中，与全身炎症反应相关的临床参数具有可比性。
背景：NCT03216720。
方法：接受冠状动脉旁路移植术的患者随机分为MiECC（n=30）和CECC（n=30）。主要终点为肿瘤坏死因子-α。次要终点是炎症的其他生化标志物(IL1β，IL6和IL8，C反应蛋白，白细胞)，以及组织灌注不足和组织损伤的标志物(乳酸脱氢酶，乳酸和肌酸激酶-MB）。此外,我们记录了全身炎症反应综合征的迹象，血流动力学不稳定，心房颤动,呼吸功能障碍,和感染。
结果：接受MiECC治疗的患者在体外循环期间和体外循环后早期的肿瘤坏死因子-α水平明显低于CECC（中位数：MiECC3.4pg/mL；CI2.2-4.5vs.CECC4.6pg/mL；CI3.4-5.6；p=0.01）。较低水平的肌酸激酶-MB和乳酸脱氢酶表明组织损伤较小。然而,我们没有检测到其他炎症标志物的显著差异，组织损伤或任何临床结果。
结论：与CECC相比，MiECC后TNF-α水平降低可能反映了炎症反应降低，尽管其他炎症生化标志物具有可比性。我们的结果表明，与CECC相比，MiECC具有更好的末端器官保护作用。在这项研究中，与全身炎症反应相关的临床参数具有可比性。
背景：NCT03216720。
