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哪种方法对保留肺功能的效果更好:体外循环中短期去白细胞输血抑或长期去白细胞输血?
Which is better to preserve pulmonary function: Short-term or prolonged leukocyte depletion during cardiopulmonary bypass?
Tao, K., An, Q., Lin, K., Lui, R.C., Wu, X., Zhou, J., Du, L.  2009/12/29 11:11:00 
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Journal of Thoracic and Cardiovascular Surgery, 2009, Volume 138, Issue 6 
 

Objectives: Neutrophils are crucial in the development of acute lung injuries during cardiopulmonary bypass. However, the efficacy of leukocyte depletion on pulmonary protection remains controversial, possibly owing to different filtration strategies used in the literature. In this study, we investigated whether short-term leukocyte depletion strategy is more efficacious than prolonged leukocyte depletion in preserving pulmonary function. Methods: Eighteen adult dogs were randomized equally into 3 groups. Leukocyte-depleting filters were used for 10 minutes in the LD-S group, throughout cardiopulmonary bypass in the LD-T group, and not used in the control group. Neutrophil counts, elastase, and interleukin-8 concentrations in plasma, myeloperoxidase and interleukin-8 concentrations in pulmonary tissue, and pulmonary vascular resistance and oxygen index were determined to evaluate the inflammatory response and damage to pulmonary function. Results: Although the neutrophil count and pulmonary parenchymal myeloperoxidase contents were significantly lower in both LD-S and LD-T groups than that in the control group, lower pulmonary parenchymal interleukin-8 level, lower pulmonary vascular resistance (113 ± 33 dyne · s/cm5), higher oxygen index (366 ± 82.3 mm Hg), and thinner alveolus wall thickness were seen only in the LD-S group, and the pulmonary parenchymal interleukin-8 levels were also lower in the LD-S group after cardiopulmonary bypass. The plasma elastase and interleukin-8 levels were significantly lower in the LD-S group, but they were significantly higher in the LD-T group compared with the control group after cardiopulmonary bypass. Conclusions: Short-term rather than prolonged leukocyte depletion during cardiopulmonary bypass appears to be more efficacious in protecting pulmonary function via attenuation of the extracorporeal circulation-induced inflammatory response. Crown Copyright © 2009.

Correspondence Address: Du, L.; Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; email:dulei1972@yahoo.cn 
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摘自:《西氏内科学》,第23

 

患者女性,21岁,因干咳、间歇性气促2个月到急诊科就诊。开始症状为上呼吸道感染引起的鼻塞、流涕和咳嗽。医生检查后开了抗生素。服药后鼻部症状缓解,但仍有轻微干咳和呼吸困难。其他症状包括疲劳和焦虑。否认发热、体重减轻、胸痛、端坐呼吸、气喘、鼻后滴漏、胃灼热以及神经系统症状。

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