Abstract
Objective: to reveal possible causes of postoperative multiple organ dysfunction syndrome (MODS) in patients after surgery under extracorporeal circulation (EC), by measuring the level and balance of pro- and anti-inflammatory cytokines. Subjects and methods. The investigation enrolled 162 patients who had undergone operations on the heart and thoracic aorta. The levels of interleukins (IL)-6, IL-8, and IL-10 were determined by ELISA. Results. At surgery under EC, MODS was encountered in 5.7%, mortality was 55.6%. The principal causes of MODS were prolonged EC concurrent with bleeding (23%), massive hemorrhage (16%), perioperative myocardial infarction and cardiogenic shock (15%), prolonged EC (12%), acute lung injury (12%), disseminated intravascular coagulation (10%), allergic and anaphylactic reactions (9%), and intravascular hemolysis (6%). The levels of pro- and anti-inflammatory cytokines were substantially increased in all the patients after surgery under EC irrespective of the presence of MODS in the postoperative period. The patients with MODS displayed pro- and anti-inflammatory cytokine imbalance due to a preponderance of the proinflammatory activity of a systemic response. During massive hemorrhage (more than 20 ml/kg), the patients with MODS exhibited a reduction in the two pools of cytokines. In the absence of MODS, there was a parallel increase in both pro- and anti-inflammatory cytokines. The magnitude of a change in the level of cytokines is related to the volume of blood loss. During prolonged EC (more than 170 min), the patients with MODS had a higher pro- and anti-inflammatory cytokine ratio due to the elevated levels of both pools, but the elevation of anti-inflammatory cytokines was more pronounced. In the patients without MODS, the values of both groups of interleukins were sigmficantly unchanged with longer duration of EC. Key words: multiple organ dysfunction syndrome, systemic inflammatory reaction, interleukins 6, 8, 10, extracorporeal circulation, operations on the heart and thoracic aorta.
Highlights
The levels of interleukins (IL) 6, IL 8, and IL 10 were determined by ELISA
The levels of pro and anti inflammatory cytokines were substantially increased in all the patients after surgery under extracorporeal circulation (EC) irrespective of the presence of multiple organ dysfunction syndrome (MODS) in the postoperative period
During massive hemorrhage, the patients with MODS exhibited a reduction in the two pools of cytokines
Summary
The investigation enrolled 162 patients who had undergone operations on the heart and thoracic aorta. The levels of pro and anti inflammatory cytokines were substantially increased in all the patients after surgery under EC irrespective of the presence of MODS in the postoperative period. The patients with MODS displayed pro and anti inflammatory cytokine imbalance due to a preponderance of the proinflammatory activity of a sys temic response. In the absence of MODS, there was a parallel increase in both pro and anti inflammatory cytokines. During prolonged EC (more than 170 min), the patients with MODS had a higher pro and anti inflammatory cytokine ratio due to the elevated levels of both pools, but the elevation of anti inflammatory cytokines was more pronounced. В настоящее время следует признать доказанным, что пусковым механизмом многообразных причин раз вития ПОН, после операций в условиях ИК является си стемная воспалительная реакция (СВР) («Whole body inflammatory reaction after cardiopulmonary bypass»). Целью настоящего исследования явилось выявле ние возможных причин возникновения ПОН в после операционном периоде у больных после операций в ус ловиях ИК, на основе изучения уровня и баланса про и противоспалительных цитокинов
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