新型低预充体外循环装置在心脏外科手术中应用的系列研究
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摘要
本课题将研究的这种新型低预充体外循环装置是为探索减轻体外循环血液稀释和全身性炎症反应(SIRS)等体外循环副作用而设计，适用于各种心外科手术的小型体外循环装置。该体外循环装置由DeltaStream~(TM)斜向血流泵、氧合器、滤器、蓄血罐组成，具标准心肺机的所有功能，整个系统可紧靠手术区头部放置。课题中研究新型低预充体外循环装置的建立、新型低预充体外循环在心脏外科手术中的血液保护和心肌保护作用，以及对围术期全身炎性反应(SIRS)的影响。结果显示新型低预充体外循环装置在动物实验和心外科搭桥手术临床应用中获成功建立和安全灌注。此新型低预充体外循环能减少血液稀释，减少围术期输血量，保护血液，且利于临床术后康复。同时，新型低预充体外循环组围术期细胞因子分泌量较经典体外循环组明显减少，起到抑制全身性炎性反应的作用。研究表明此新型低预充体外循环装置在心脏外科手术中有广泛的临床应用前景。
The new low-priming cardiopulmonary bypass setup which is brought closer to the patient is one of the latest attempts in minimizing hemodilution, blood damage, and attenuating the systemic inflammatory response for patients undergoing all fields of cardiac surgery. This setup incorporates the DeltaStream diagonal pump, oxygenator, filter and reservoir with all of the features of CPB. This study is conducted to evaluate the effects in coronary bypass surgery with new system compared with standard CPB on hemodilution, transfusion, myocardial damage and systemic inflammatory response. Safety studies have demonstrated safe use of the new system in animal experiment and clinical coronary bypass surgery without any side effects. In this study, this new setup has shown significant reduction of hemodilution, reduction of the need for homologous blood transfusion, attenuation of the systemic inflammatory response and maintenance of better clinical outcome. The present study provided the potential application of this new system in cardiac surgery.
The new low-priming cardiopulmonary bypass setup which is brought closer to the patient is one of the latest attempts in minimizing hemodilution, blood damage, and attenuating the systemic inflammatory response for patients undergoing all fields of cardiac surgery. This setup incorporates the DeltaStream diagonal pump, oxygenator, filter and reservoir with all of the features of CPB. This study is conducted to evaluate the effects in coronary bypass surgery with new system compared with standard CPB on hemodilution, transfusion, myocardial damage and systemic inflammatory response. Safety studies have demonstrated safe use of the new system in animal experiment and clinical coronary bypass surgery without any side effects. In this study, this new setup has shown significant reduction of hemodilution, reduction of the need for homologous blood transfusion, attenuation of the systemic inflammatory response and maintenance of better clinical outcome. The present study provided the potential application of this new system in cardiac surgery.
引文
1 Gutzwiller F. Monitoring of cardiovascular disease and risk factor trends: experiences from the WHO/MONICA project. Ann Med 1994; 26:61-65.
2 Schmitz C, Weinrich S, Schneider R, et al. Off-Pump versus on-pump coronary artery bypass: can OPCAB reduce neurologic injury? Heart Surg Forum 2003; 6:127-130.
3 Kirklin JK, Barrat-Boyes BG. Cardiac surgery. 1993.2nd ed. New York, NY: Churchill Livingstone.
4 Hsu LC. Heparin-coated cardiopulmonary bypass circuits: current status. Perfusion 2001; 16:417-28.
5 Shapira OM, Aldea GS, Treanor PR, et al.. Reduction of allogeneic blood transfusions after open heart operations by lowering cardiopulmonary bypass prime. Ann Thorac Surg 1998; 65:724-730.
6 Swaminathan M, Phillips-Bute BG, Conlon PJ, Smith PK, Newman MF, Stafford-Smith M. The association of lowest hematocrit during cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery. Ann Thorac Surg. 2003; 76:784-791.
7 Lillehei CW. Historical development of cardiopulmonary bypass. In: Gravlee GP, Davis RF, Utley JR eds. Cardiopulmonary bypass: principles and practice. Baltimore, MD: Williams&Wilkins, 1993:1-26.
8 Stover EP, Siegel LC, Parks R, et al. Variability in transfusion practice for coronary artery bypass surgery persists despite national consensus guidelines:
a 24-institution study. Institutions of the Multicenter Study of Perioperative Ischemia Research Group. Anesthesiology 1998; 88:327-333.
9 Defoe GR, Ross CS, Olmstead EM, et al. Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting. Northern New England Cardiovascular Disease Study Group. Ann Thorac Surg. 2001; 71: 769-776.
10 Fang WC, Helm RE, Krieger KH, et al. Impact of minimum hematocrit during cardiopulmonary bypass on mortality in patients undergoing coronary artery surgery. Circulation 1997; 96 (Suppl. Ⅱ): 194-199.
11 Hornick P, George A. Blood contact activation: pathophysiological effects and therapeutic approaches. Perfusion 1996; 11:3-19.
12 Jansen PG, Te Velthuis H, Oudemans-Van Straaten HM, et al. Perfusion-related factors of endotoxin release during cardiopulmonary bypass. Eur J Cardiothorac Surg 1994; 8:125-129.
13 Brasil LA, Gomes WJ, Salomao R, Buffolo E. Inflammatory response after myocardial revascularization with or without cardiopulmonary bypass. Ann Thorac Surg 1998; 66:56-59.
14 Plomondon ME, Cleveland JC Jr, Ludwig ST, et al. Off-pump coronary artery bypass is associated with improved risk-adjusted outcomes. Ann Thorac Surg 2001; 72:114-119.
15 Amano A, Hirose H, Takahashi A, Nagano N. Off-pump coronary artery bypass. Mid-term results. Jpn J Thorac Cardiovasc Surg 2001; 49:67-78.
16 Jurmann MJ, Menon AK, Haeberle L, Salehi-Gilani S, Ziemer G. Left ventricular geometry and cardiac function during minimally invasive coronary artery bypass grafting. Ann Thorac Surg 1998; 66:1082-1086.
17 Fromes Y, Gaillard D, Ponzio O, et al. Reduction of the inflammatory response following coronary bypass grafting with total minimal extracorporeal circulation. Eur J Cardiothorac Surg. 2002; 22:527-533.
18 Vaislic C, Bical O, Farge C, et al. Totally Minimized Extracorporeal Circulation: An Important Benefit for Coronary Artery Bypass Grafting in Jehovah's Witnesses. Heart Surg Forum. 2003; 6:307-310.
19 Liebold A, Philipp A, Birnbaum D. Minimal Extracorporeal Circulation (MECC)-a new technique to facilitate complete coronary revascularization on the beating heart. Thorac Cardiovasc Surg 2000; 48 (Suppl. Ⅰ): 81.
20 Goebel C, Arvand A, Rau G, et al. A new rotary blood pump for versatile extracorporeal circulation: the DeltaStream. Perfusion 2002; 17:373-382.
21 Goebel C, Arvand A, Eilers R, et al. Development of the MEDOS/HIA DeltaStream extracorporeal rotary blood pump. Artif Organs 2001; 25:358-365.
22 Rosengart TK, DeBois W, O'Hara M, et al. Retrograde autologous priming for cardiopulmonary bypass: a safe and effective means of decreasing hemodilution and transfusion requirements. J Thorac Cardiovasc Surg. 1998; 115:426-438.
23 Debase WJ, McZee JJ, Sukhram Y, et al. Significant pump prime reduction decreases the need for homologous transfusion. Proc Am Acad Cardiovasc Perf 1997; 18: 183-187.
24 Calafiore AM, Teodori G, Mezzetti A, et al. Intermittent antegrade warm blood cardioplegia. Ann Thorac Surg 1995; 59:398-402.
25 Royston D, Bidstrup BP, Taylor KM, Sapsford RN. Effect of aprotinin on need for blood transfusion after repeat open-heart surgery. Lancet 1987; 2:1289-1291.
26 Gravlee GP, Davis RF, Kurusz M, Utley JR, eds. Cardiopulmonary bypass. (2nd) Philadelphia, PA: Lippincott Williams & Wilkins 2000.
27 Wan S, LeClerc JL, Vincent JL. Inflammatory response to cardiopulmonary bypass: mechanisms involved and possible therapeutic strategies. Chest 1997; 112:676-92.
28 Kirklin JK, Westaby S, Blackstone EH, Kirklin JW, Chenoweth DE, Pacifico AD. Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg 1983; 86:845-857.
29 Morgan IS, Codispoti M, Sanger K, Mankad PS. Superiority of centrifugal pump over roller pump in paediatric cardiac surgery: prospective randomised trial. Eur J Cardiothorac Surg. 1998; 13:526-532.
30 Czerny M, Baumer H, Kilo J, et al. Complete revascularization in coronary artery bypass grafting with and without cardiopulmonary bypass. Ann Thorac Surg 2001; 71:165-169.
31 Arom KV, Flavin TF, Emery RW, Kshettry VR, et al. Safety and efficacy of off-pump coronary artery bypass grafting Ann Thorac Surg 2000; 69:704-10.
32 Beholz S, Konertz W. Minimalinvasive chirurgische koronare Revaskularisation: Gegenwrtiger Stand und Ausblick in die Zukunft. Chirurgische Praxis 2002; 60:687-700.
33 Mathison M, Edgerton JR, Horswell JL, Akin JJ, Mack MJ. Analysis of hemodynamie changes during beating heart surgical procedures. Ann Thorac Surg 2000; 70:1355-1360.
34 Meyns B, Autschbach R, Boning A, et al. Coronary artery bypass grafting supported with intracardiac microaxial pumps versus normothermic cardiopulmonary bypass: a prospective randomized trial. Eur J Cardiothorac Surg 2002; 22: 112-117.
35 Panico FG, Neptune WB. A mechanism to eliminate the donor blood prime from the pump oxygenator. Surg Forum 1960; 10: 605-109.
36 Cooper JR, Slogoff S. Hemodilution and priming solutions for cardiopulmonary bypass. In: Gravlee GP, Davis RF, Utley JR eds. Cardiopulmonary bypass: principles and practice. Baltimore, MD: Williams&Wilkins, 1993: 124.
37 Cooley DA, Beall AC, Grondin P. Open-heart operations with disposable oxygenators, 5 per cent dextrose prime, and normothermia. Surgery 1962; 52: 713-19.
38 Jeffrey L, Amy Duff, Roy M, Jesse A, et al. Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet 1996; 348: 1055-1060.
39 Gravlee GP, Davis RF, Kurusz M, et al. Cardiopulmonary bypass, principles and practice. 2000.2nd ed. Philadelphia: Lippincott Williams & Wilkins, 186-96.
40 Hardy JF, Martineau R, Couturier A, Belisle S, Cartier R, Carrier M. Influence of haemoglobin concentration after extracorporeal circulation on mortality and morbidity in patients undergoing cardiac surgery. Br J Anaesth. 1998; 81 (Suppl 1): 38-45.
41 McCusker K, Vijay V, DeBois W, Helm R, Sisto D. MAST system: a new condensed cardiopulmonary bypass circuit for adult cardiac surgery. Perfusion 2001; 16:447-452.
42 Kazmi WH, Kausz AT, Khan S, et al. Anemia: an early complication of chronic renal insufficiency. Am J Kidney Dis 2001; 38:803-812.
43 Nollert G, Sperling J, Sakamoto T, Jaeger BR, Jonas RA. Higher hematocrit improves liver blood flow and metabolism during cardiopulmonary bypass in piglets. Thorac Cardiov Surg 2001; 49:226-30.
44 Cummins P, Young A, Ackland ML,et al. Comparion of serum cardiac specific troponin Ⅰ with creatine kinase, creatine kinase-MB isoenzyme, tropomyosin, myoglobin and c-reactive protein release in marathon runners: cardiac or skeletal muscle trauma? Eur J Clin Invest 1987; 17:317-23.
45 Katus HA, Remppis A, Looser S, et al. Serum concentration changes of cTnT in patients with AMI. J Mol Cell Cardiol 1989; 21: 1349-51.
46 Gerkardt W, Katus H, Ravkilde J, et al. S-Troponin in suspected-ischemic myocardial injury compared with mass and catalytic concentrations of S-creatine kinase isoenzynme MB. Clin Chem 1997; 37: 1405-1407.
47 Wu A, Jr RV, Apple FS, et al. Cardiac troponin immunoassay for diagnosis of acute myocardial infarction. Chin Chem 1994; 40: 90-94.
48 Adams JE,Bodor GS,Davila-Roman VG, et al. Cardiac troponin Ⅰ: a marker with high specificity for cardiac injury. Circulation 1993; 88:101.
49 Mair J, Wagner I, Puschendorf B, et al. Cardiac troponin Ⅰ. to diagnose myocardial injury. Lancet 1993; 341:838.
50 Katus HA, Remppis A, Scheffold T, et al. Intracellular compartmentation of cardiac troponis T and its release kinetics in patients with reperfused and nonreperfused myocardial infarction. Am J Cardial 1991; 67:1360.
51 Mair J, Dienstl F, Puschendorf B. Cardiac troponin T in the diagnosis of myocardial injury. Crit Rev Clin Lab Sci 1992; 29:31-57.
52 Wu AH. Cardiac troponin T: Biochemical, analytical and clinical aspects. J Clin Immunoassay 1994; 17:45-48.
53 American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992; 20:864-
874.
54 Gourlay T. Biomaterial development for cardiopulmonary bypass. Perfusion. 2001; 16:381-390.
55 Hornick P, George A. Blood contact activation: pathophysiological effects and therapeutic approaches. Perfusion 1996; 11:3-19.
56 Boyle EM, Pohlman TH, Johnson MC, Verrier ED. Endothelial cell injury in cardiovascular surgery: the systemic inflammatory response. Ann Thorac Surg 1997; 63:277-284.
57 Wan S, LeClerc JL, Vincent JL. Inflammatory response to cardiopulmonary bypass: mechanisms involved and possible therapeutic strategies. Chest, 1997; 112: 676-92.
58 Casey LC. Role of cytokines in the pathogenesis of cardiopulmonary-induced multisystem organ failure. Ann Thorac Surg 1993; 56: S92-S96.
59 Wan S, LeClerc JL, Vincent JL. Cytokine responses to cardiopulmonary bypass: lessons learned from cardiac transplantation.Ann Throas Surg, 1997,63:269-76.
60 Edmunds LH. Why cardiopulmonary bypass makes patients sick: strategies to control the blood-synthetic surface interface. In: Karp RB, Laks H. Advances in cardiac surgery; Vol 6. St. Louis: Mosby-Year Book,1995:131-167.
61 Edmunds LH. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 1998; 66:S12-S16.
62 Nobuya Murakami. Ulinastatin(UTI), Novel Clinical application and recent results obtained from the UTI-knockout mouse. 组织培养工学 (日), 2001; 27 (9): 22-28.
63 Christophe Baufreton, Liliane Intrator, Piet G., et al. Inflammatory response to cardiopulmonary bypass using roller or centrifugal pumps. Ann Thorac Surg 1999; 67: 972-7.
64 Hardy JF, Martineau R, Couturier A, Belisle S, Cartier R, Carrier M. Influence of haemoglobin concentration after extracorporeal circulation on mortality and morbidity in patients undergoing cardiac surgery. Br J Anaesth. 1998; 81 (Suppl 1): 38-45.
65 Butler J, Chong GL, Baigrie RJ, Pillai R, Westaby S, Rocker GM. Cytokine responses to cardiopulmonary bypass with membrane and bubble oxygenation. Ann Thorac Surg 1992; 53:833-838.
66 Butler J, Rocker GM, Westaby S. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 1993; 55:552-559.
67 Jansen PG, Te Velthuis H, Oudemans-Van Straaten HM, et al. Perfusion-related factors of endotoxin release during cardiopulmonary bypass. Eur J Cardiothorac Surg 1994; 8: 125-129.
2 Schmitz C, Weinrich S, Schneider R, et al. Off-Pump versus on-pump coronary artery bypass: can OPCAB reduce neurologic injury? Heart Surg Forum 2003; 6:127-130.
3 Kirklin JK, Barrat-Boyes BG. Cardiac surgery. 1993.2nd ed. New York, NY: Churchill Livingstone.
4 Hsu LC. Heparin-coated cardiopulmonary bypass circuits: current status. Perfusion 2001; 16:417-28.
5 Shapira OM, Aldea GS, Treanor PR, et al.. Reduction of allogeneic blood transfusions after open heart operations by lowering cardiopulmonary bypass prime. Ann Thorac Surg 1998; 65:724-730.
6 Swaminathan M, Phillips-Bute BG, Conlon PJ, Smith PK, Newman MF, Stafford-Smith M. The association of lowest hematocrit during cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery. Ann Thorac Surg. 2003; 76:784-791.
7 Lillehei CW. Historical development of cardiopulmonary bypass. In: Gravlee GP, Davis RF, Utley JR eds. Cardiopulmonary bypass: principles and practice. Baltimore, MD: Williams&Wilkins, 1993:1-26.
8 Stover EP, Siegel LC, Parks R, et al. Variability in transfusion practice for coronary artery bypass surgery persists despite national consensus guidelines:
a 24-institution study. Institutions of the Multicenter Study of Perioperative Ischemia Research Group. Anesthesiology 1998; 88:327-333.
9 Defoe GR, Ross CS, Olmstead EM, et al. Lowest hematocrit on bypass and adverse outcomes associated with coronary artery bypass grafting. Northern New England Cardiovascular Disease Study Group. Ann Thorac Surg. 2001; 71: 769-776.
10 Fang WC, Helm RE, Krieger KH, et al. Impact of minimum hematocrit during cardiopulmonary bypass on mortality in patients undergoing coronary artery surgery. Circulation 1997; 96 (Suppl. Ⅱ): 194-199.
11 Hornick P, George A. Blood contact activation: pathophysiological effects and therapeutic approaches. Perfusion 1996; 11:3-19.
12 Jansen PG, Te Velthuis H, Oudemans-Van Straaten HM, et al. Perfusion-related factors of endotoxin release during cardiopulmonary bypass. Eur J Cardiothorac Surg 1994; 8:125-129.
13 Brasil LA, Gomes WJ, Salomao R, Buffolo E. Inflammatory response after myocardial revascularization with or without cardiopulmonary bypass. Ann Thorac Surg 1998; 66:56-59.
14 Plomondon ME, Cleveland JC Jr, Ludwig ST, et al. Off-pump coronary artery bypass is associated with improved risk-adjusted outcomes. Ann Thorac Surg 2001; 72:114-119.
15 Amano A, Hirose H, Takahashi A, Nagano N. Off-pump coronary artery bypass. Mid-term results. Jpn J Thorac Cardiovasc Surg 2001; 49:67-78.
16 Jurmann MJ, Menon AK, Haeberle L, Salehi-Gilani S, Ziemer G. Left ventricular geometry and cardiac function during minimally invasive coronary artery bypass grafting. Ann Thorac Surg 1998; 66:1082-1086.
17 Fromes Y, Gaillard D, Ponzio O, et al. Reduction of the inflammatory response following coronary bypass grafting with total minimal extracorporeal circulation. Eur J Cardiothorac Surg. 2002; 22:527-533.
18 Vaislic C, Bical O, Farge C, et al. Totally Minimized Extracorporeal Circulation: An Important Benefit for Coronary Artery Bypass Grafting in Jehovah's Witnesses. Heart Surg Forum. 2003; 6:307-310.
19 Liebold A, Philipp A, Birnbaum D. Minimal Extracorporeal Circulation (MECC)-a new technique to facilitate complete coronary revascularization on the beating heart. Thorac Cardiovasc Surg 2000; 48 (Suppl. Ⅰ): 81.
20 Goebel C, Arvand A, Rau G, et al. A new rotary blood pump for versatile extracorporeal circulation: the DeltaStream. Perfusion 2002; 17:373-382.
21 Goebel C, Arvand A, Eilers R, et al. Development of the MEDOS/HIA DeltaStream extracorporeal rotary blood pump. Artif Organs 2001; 25:358-365.
22 Rosengart TK, DeBois W, O'Hara M, et al. Retrograde autologous priming for cardiopulmonary bypass: a safe and effective means of decreasing hemodilution and transfusion requirements. J Thorac Cardiovasc Surg. 1998; 115:426-438.
23 Debase WJ, McZee JJ, Sukhram Y, et al. Significant pump prime reduction decreases the need for homologous transfusion. Proc Am Acad Cardiovasc Perf 1997; 18: 183-187.
24 Calafiore AM, Teodori G, Mezzetti A, et al. Intermittent antegrade warm blood cardioplegia. Ann Thorac Surg 1995; 59:398-402.
25 Royston D, Bidstrup BP, Taylor KM, Sapsford RN. Effect of aprotinin on need for blood transfusion after repeat open-heart surgery. Lancet 1987; 2:1289-1291.
26 Gravlee GP, Davis RF, Kurusz M, Utley JR, eds. Cardiopulmonary bypass. (2nd) Philadelphia, PA: Lippincott Williams & Wilkins 2000.
27 Wan S, LeClerc JL, Vincent JL. Inflammatory response to cardiopulmonary bypass: mechanisms involved and possible therapeutic strategies. Chest 1997; 112:676-92.
28 Kirklin JK, Westaby S, Blackstone EH, Kirklin JW, Chenoweth DE, Pacifico AD. Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg 1983; 86:845-857.
29 Morgan IS, Codispoti M, Sanger K, Mankad PS. Superiority of centrifugal pump over roller pump in paediatric cardiac surgery: prospective randomised trial. Eur J Cardiothorac Surg. 1998; 13:526-532.
30 Czerny M, Baumer H, Kilo J, et al. Complete revascularization in coronary artery bypass grafting with and without cardiopulmonary bypass. Ann Thorac Surg 2001; 71:165-169.
31 Arom KV, Flavin TF, Emery RW, Kshettry VR, et al. Safety and efficacy of off-pump coronary artery bypass grafting Ann Thorac Surg 2000; 69:704-10.
32 Beholz S, Konertz W. Minimalinvasive chirurgische koronare Revaskularisation: Gegenwrtiger Stand und Ausblick in die Zukunft. Chirurgische Praxis 2002; 60:687-700.
33 Mathison M, Edgerton JR, Horswell JL, Akin JJ, Mack MJ. Analysis of hemodynamie changes during beating heart surgical procedures. Ann Thorac Surg 2000; 70:1355-1360.
34 Meyns B, Autschbach R, Boning A, et al. Coronary artery bypass grafting supported with intracardiac microaxial pumps versus normothermic cardiopulmonary bypass: a prospective randomized trial. Eur J Cardiothorac Surg 2002; 22: 112-117.
35 Panico FG, Neptune WB. A mechanism to eliminate the donor blood prime from the pump oxygenator. Surg Forum 1960; 10: 605-109.
36 Cooper JR, Slogoff S. Hemodilution and priming solutions for cardiopulmonary bypass. In: Gravlee GP, Davis RF, Utley JR eds. Cardiopulmonary bypass: principles and practice. Baltimore, MD: Williams&Wilkins, 1993: 124.
37 Cooley DA, Beall AC, Grondin P. Open-heart operations with disposable oxygenators, 5 per cent dextrose prime, and normothermia. Surgery 1962; 52: 713-19.
38 Jeffrey L, Amy Duff, Roy M, Jesse A, et al. Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet 1996; 348: 1055-1060.
39 Gravlee GP, Davis RF, Kurusz M, et al. Cardiopulmonary bypass, principles and practice. 2000.2nd ed. Philadelphia: Lippincott Williams & Wilkins, 186-96.
40 Hardy JF, Martineau R, Couturier A, Belisle S, Cartier R, Carrier M. Influence of haemoglobin concentration after extracorporeal circulation on mortality and morbidity in patients undergoing cardiac surgery. Br J Anaesth. 1998; 81 (Suppl 1): 38-45.
41 McCusker K, Vijay V, DeBois W, Helm R, Sisto D. MAST system: a new condensed cardiopulmonary bypass circuit for adult cardiac surgery. Perfusion 2001; 16:447-452.
42 Kazmi WH, Kausz AT, Khan S, et al. Anemia: an early complication of chronic renal insufficiency. Am J Kidney Dis 2001; 38:803-812.
43 Nollert G, Sperling J, Sakamoto T, Jaeger BR, Jonas RA. Higher hematocrit improves liver blood flow and metabolism during cardiopulmonary bypass in piglets. Thorac Cardiov Surg 2001; 49:226-30.
44 Cummins P, Young A, Ackland ML,et al. Comparion of serum cardiac specific troponin Ⅰ with creatine kinase, creatine kinase-MB isoenzyme, tropomyosin, myoglobin and c-reactive protein release in marathon runners: cardiac or skeletal muscle trauma? Eur J Clin Invest 1987; 17:317-23.
45 Katus HA, Remppis A, Looser S, et al. Serum concentration changes of cTnT in patients with AMI. J Mol Cell Cardiol 1989; 21: 1349-51.
46 Gerkardt W, Katus H, Ravkilde J, et al. S-Troponin in suspected-ischemic myocardial injury compared with mass and catalytic concentrations of S-creatine kinase isoenzynme MB. Clin Chem 1997; 37: 1405-1407.
47 Wu A, Jr RV, Apple FS, et al. Cardiac troponin immunoassay for diagnosis of acute myocardial infarction. Chin Chem 1994; 40: 90-94.
48 Adams JE,Bodor GS,Davila-Roman VG, et al. Cardiac troponin Ⅰ: a marker with high specificity for cardiac injury. Circulation 1993; 88:101.
49 Mair J, Wagner I, Puschendorf B, et al. Cardiac troponin Ⅰ. to diagnose myocardial injury. Lancet 1993; 341:838.
50 Katus HA, Remppis A, Scheffold T, et al. Intracellular compartmentation of cardiac troponis T and its release kinetics in patients with reperfused and nonreperfused myocardial infarction. Am J Cardial 1991; 67:1360.
51 Mair J, Dienstl F, Puschendorf B. Cardiac troponin T in the diagnosis of myocardial injury. Crit Rev Clin Lab Sci 1992; 29:31-57.
52 Wu AH. Cardiac troponin T: Biochemical, analytical and clinical aspects. J Clin Immunoassay 1994; 17:45-48.
53 American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992; 20:864-
874.
54 Gourlay T. Biomaterial development for cardiopulmonary bypass. Perfusion. 2001; 16:381-390.
55 Hornick P, George A. Blood contact activation: pathophysiological effects and therapeutic approaches. Perfusion 1996; 11:3-19.
56 Boyle EM, Pohlman TH, Johnson MC, Verrier ED. Endothelial cell injury in cardiovascular surgery: the systemic inflammatory response. Ann Thorac Surg 1997; 63:277-284.
57 Wan S, LeClerc JL, Vincent JL. Inflammatory response to cardiopulmonary bypass: mechanisms involved and possible therapeutic strategies. Chest, 1997; 112: 676-92.
58 Casey LC. Role of cytokines in the pathogenesis of cardiopulmonary-induced multisystem organ failure. Ann Thorac Surg 1993; 56: S92-S96.
59 Wan S, LeClerc JL, Vincent JL. Cytokine responses to cardiopulmonary bypass: lessons learned from cardiac transplantation.Ann Throas Surg, 1997,63:269-76.
60 Edmunds LH. Why cardiopulmonary bypass makes patients sick: strategies to control the blood-synthetic surface interface. In: Karp RB, Laks H. Advances in cardiac surgery; Vol 6. St. Louis: Mosby-Year Book,1995:131-167.
61 Edmunds LH. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 1998; 66:S12-S16.
62 Nobuya Murakami. Ulinastatin(UTI), Novel Clinical application and recent results obtained from the UTI-knockout mouse. 组织培养工学 (日), 2001; 27 (9): 22-28.
63 Christophe Baufreton, Liliane Intrator, Piet G., et al. Inflammatory response to cardiopulmonary bypass using roller or centrifugal pumps. Ann Thorac Surg 1999; 67: 972-7.
64 Hardy JF, Martineau R, Couturier A, Belisle S, Cartier R, Carrier M. Influence of haemoglobin concentration after extracorporeal circulation on mortality and morbidity in patients undergoing cardiac surgery. Br J Anaesth. 1998; 81 (Suppl 1): 38-45.
65 Butler J, Chong GL, Baigrie RJ, Pillai R, Westaby S, Rocker GM. Cytokine responses to cardiopulmonary bypass with membrane and bubble oxygenation. Ann Thorac Surg 1992; 53:833-838.
66 Butler J, Rocker GM, Westaby S. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 1993; 55:552-559.
67 Jansen PG, Te Velthuis H, Oudemans-Van Straaten HM, et al. Perfusion-related factors of endotoxin release during cardiopulmonary bypass. Eur J Cardiothorac Surg 1994; 8: 125-129.