Transpulmonary Sequestration of Leukocyte and Changes of Peripheral Leukocyte Counts with Card iopu Imonary Bypass

체외순환에 따른 백혈구의 폐내정체와 말초혈액내 숫적 동태에 관한 연구

  • Kim, Yun-Gyu (Department of Thoracic and Cardiovascular Surgery, Pusan Pail Hospital, College of Medicine, Inje University) ;
  • Kim, Yang-Won (Department of Thoracic and Cardiovascular Surgery, Pusan Pail Hospital, College of Medicine, Inje University) ;
  • Choe, Seok-Cheol (Department of Extracorporeal Circulation of Thoracic and Cardiovascular Surgery, Pusan Paik Hospital, College of Medicine, Inje University) ;
  • Jo, Gwang-Hyeon (Department of Thoracic and Cardiovascular Surgery, Pusan Pail Hospital, College of Medicine, Inje University)
  • 김윤규 (인제대학교 부산백병원 흉부외과학교실) ;
  • 김양원 (인제대학교 부산백병원 흉부외과학교실) ;
  • 최석철 (인제대학교 부산백병원 흉부외과학교실, 인제대학교 부산백병 원 흉부외과 체외심폐순환실) ;
  • 조광현 (인제대학교 부산백병원 흉부외과학교실)
  • Published : 1996.07.01

Abstract

Transpulmonary sequestration of leukocyte following cardiopulmonary bypass(CPB) has been recognized as one of main causes of postoperative pulmonary dysfunction. The purpose of this study is to investigate the effect of a single dose of prebypass corticosteroid on pulmonary leukostasis and postoperative pulmonary dysfunction. The study was performed prospectively in randomized-blind fas ion for 50 patients from January 1995 to June 1995. All patients were divided into two groups; In the steroid group(n=25), corticosteroid(Solu-Medrol 30mg1kg) was injected prior to CPB and in the placebo group (n=25), normal saline was injected before CPB. The results were summarized as follows. 1. Total peripheral leukocyte counts decreased significantly at 5 minutes of CPB in all patients(P<0.01), and began to increase progressively at later periods of CPB with neutrophilia. The significant rise remained at postoperative 7th day. 2. During partial CPB, transpulmonary leukostasis occurred in placebo group(P< 0.001), whereas it was prevented in steroid group. 3. In both groups, peripheral Lymphocyte counts were stable during CPB, but began to reduce at time of intensive care unit(ICV) and the Iymphocytopenia remained until postoperative )rd day. The Iympho- cyte counts recovered on postoperative 7th day. 4. In both groups, peripheral counts of monocyte were relatively stable in the e rly peroid of CPB, and increased gradually in the later periods of CPB. This significant monocytosis remained throughout postoperative periods(P< 0.05). 5. The mean value of postoperative PaOa was lower than that of pre-CPB In placebo group(P=0.01), but in steroid group, there was no significant difference(P=0. 90) and fever was higher in placebo group compared to steroid group(P=0.001).

체외순환으로 인한 백혈구의 폐내정체는 술후 폐기능 부전의 주된 요인들 중 하나로 인식되고 있다. 본 연구의 목적은 체외순환전 투여한 부신피질 호르몬제(Solu-Medrol 30mg1kg)가 백혈구의 폐내정 체와 일부 관류후 증후군에 예방적 효과가 있는지를 규명하는데 있다. 연구는 1995년 1월부터 6월까지 부산백병원 흉부외과에서 실시된 개심술 환자중 무작위로 선정된 50 명을 대상으로 전향적 맹검법(blind fashion)으로 시행되었던바, 연구의 목적상 전체 환자를 부신피질 호 르몬제를 투여한 steroid 군(n=25)과 투여하지 않은 placebo 군(n:25)으로 나누어 검토하여 다음과 같은 결과를 얻었다. 1. 체외순환은 말초혈액의 총 백혈구수를 유의하게 변화시키는데 초기 엔 그 수를 저하시켰고 시간이 경과할수록 점차 상숭시켰으며 이러한 숫적 변화들은호중구수의 변화에 기인하였고 술후 7일까 지 유의한 증가를 보였다. 2.부분 체외순환은 백혈구의 폐내 정체를 야기시키나 고용량의 스테로이드 사용으로 예방이 가능하 였다. 3.양 군 모두에 있어 체외순환 동안 임파구수는 의미있게 변화되지 않고 체외순환 종료후 부터 3일 동안 유의한 감소를 보였으나 술후 7일엔 완전히 기준치로 회복되 었다. 4. 단구수는 양 군 모두 체외순환 초기 엔 큰 변화가 없다가 이후 점차 상승하여 술후 7일까지 유의한 증가가 지속되 었다. 5. 술후 동맥혈 PaO,는 placebo 군은 술전치 에 비해 감소되 었으나(P=0.01) steroid 군은 변화가 없었다 (P=0.90). 술후 발열 역시 steroid 군에 비해 placebo 군이 더 높았다(P=0.001). 이상의 결과를 통해 체외순환을 이용한 심장수술 동안 백혈구의 활성화와 폐내 정체가 관찰되.었고 steroid의 사용이 백혈구의 폐내정체를 예방해 주고술후의 일부관류후증후군을완화시켜 줌을확인할 수 있었다. 따라서 체외순환전 고용량 스테로이드의 예방적 투여가 적절한 것으로 사료된다.

Keywords

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