不停跳冠狀動脈鐃道手術使用Cdi Saver回收血液中發炎前細胞激素及附著分子不會增加

Cell Saver Does not Increase Pro-inflammatory Cytokine Levels and Expression of Adhesive Molecules in the Salvaged Blood of Patients Undergoing Off-pump Coronary Artery Bypass Surgery

背景：自體輸血可以避免傳染性疾病以及異體輸血產生之併發症。過去研究證實在體外循環之冠狀動脈繞道手術中使用cellsaver（CS）會引起發炎前細胞間質的釋放以及補體活化。由於體外循環以及CS均有可能造成細胞間質釋放，因此在此實驗我們探討只使用CS在不停跳冠狀動脈繞道手術中發炎前細胞間質滾度以及淋巴球表面抗原的表現。方法：三十個施行不停跳冠狀動脈繞道手術的病人安排在此實驗。五段手術前後的血液樣本（手術前[PRPB]，手術中心包膜腔血液[PS]，cellsaver容器內血液[CSC]，輸血前血袋內血液[BB]，手術後一小時週邊血[POPB]）自每個病人中抽取。活化淋巴球附著分子的表現（CDllb和CD18）及細胞間質引起之淋巴球內皮附著分子（CD62P）以流式細胞儀分析。發炎前細胞間質包括TNJF-a，IL-6及IL-8以ELISA分析。結果：CDllb及CD62P的表現以及處理血液過程中（PRPB, PS，CSC and BB）CP>0.1）的TNF-a，IL-6，IL-8（P>0.05）是沒有差異的，然而CD18的表現在整個自體輸血中是下降的。術後一小時的週邊血液（1POPB）顯示較高三個測試淋巴球表面抗原的表現以及較高濃度的TNF-a和IL-6（P<0.05）。結論：我們的研究顯示單獨使用cellsaver血液處理過程中，CDllb，CD18及CD62P不會增加表現而TNF-a，IL-6及IL-8的滾度也不會增加。

Background: Autotransfusion has been developed to avoid the risks of contaminating with infectious diseases and susceptivity to other complications of allogeneic blood transfusion. Previous studies have shown significant pro-inflammatory cytokine release and complement activation during blood salvage with cell saver (CS) in the course of on-pump coronary artery bypass grafting (CABG) surgery. Because both extracorporeal pump and CS machine are possible to induce the adverse cytokines release, thus, in this study, we investigated the influence of CS alone on the levels of pro-inflammatory cytokines and the expression of leukocyte surface antigens in patients undergoing off-pump CABG. Methods: Thirty patients proposed to undergo off-pump CABG were enrolled in this study. Five perioperative blood samples (peripheral blood before operation, blood in pericardial sac at operation, blood in the cell saver container, blood in the blood bag before transfusion, and peripheral blood one hour after operation) were obtained from each patient. The expression of activated leukocyte adhesive molecules (CDllb and CD 18) and cytokine- inducible leukocyte-endothelial adhesive molecule (CD62P) were studied by flow cytometry. Enzyme-linked im-munosorbent assay (ELISA) was conducted to determine the levels of pro-inflammatory cytokines including tumor necrosis factor-a (TNF-a), interleukin 6 (IL-6) and IL-8. Results: All blood samples except the one obtained one hour after operation showed no difference of the ex-pression of CDllb, and CD62P and the levels of TNF-a, IL-6 and IL-8 (P> 0.05). However, the expression of CD18 was decreased during the course of blood salvage. The peripheral blood obtained one hour after operation had significantly higher expression of the three tested leukocyte surface antigens and higher levels of three studied cytokines (P < 0.05). Conclusions: Our investigation indicated that the blood processing in cell saver alone did not increase the expression of either CDllb, CD18, or CD62P, and the levels of TNF-a, IL-6 and IL-8. The results suggest that cell saver seems not to significantly activate the leukocytes or cause inflammatory responses in the salvaged blood.