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Vol. 24. Núm. 9.
Páginas 385-391 (Diciembre 2000)
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Vol. 24. Núm. 9.
Páginas 385-391 (Diciembre 2000)
Acceso a texto completo
Importancia del TNF-α en la presentación de síndrome de bajo gasto en el postoperatorio de cirugía cardíaca con circulación extracorpórea
Importance of TNF-α in the Appearance of Low Output Syndrome in the Postoperative Period Following Heart Surgery With Extracorporeal Circulation
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5200
F. Martínez sagasti*,1, J.L. Iribarren sarrías**, C. Naranjo jarillo**, A. Lacruz urbina***, A.M. De Vera González****, M.L. Mora quintero**
* Servicio de Medicina Intensiva. Hospital San Carlos. Madrid
** Servicio de Medicina Intensiva
*** Servicio de Cirugía Cardíaca (Perfusionista)
**** Bioquímica Clínica (Laboratorio Central). Hospital Universitario de Canarias. Tenerife
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Información del artículo
Fundamento

La cirugía extracorpórea (CEC) produce un síndrome de respuesta inflamatoria sistémica (SIRS) que puede manifestarse con bajo gasto (BG), estando influido por la activación de diversas citocinas proinflamatorias (interleucina [IL]-1, IL-6, factor de necrosis tumoral [TNF]-α) y antiinflamatorias (IL-10).

Métodos

Estudio prospectivo de 31 pacientes consecutivos, con cardiopatía isquémica o valvular, intervenidos bajo CEC para analizar si la elevación del TNF-α plasmático tras la CEC (ingreso, 4 horas y 24 horas) está implicado en el desarrollo de BG.

Resultados

Sólo se pudo analizar el TNF-α plasmático en 25 pacientes. De ellos, 15 (60%) conservaron un gasto cardíaco (GC) normal y 10 (40%) desarrollaron BG. El TNF-α al ingreso estaba elevado en todos los casos. A las 24 horas, el TNF-α se encontraba significativamente más alto en el grupo de BG, normalizándose en el grupo con GC normal (12,79 [5,7] pg/ml frente a 7,52 [2,1] pg/ml; p < 0,05). No hubo diferencias en cuanto a la edad ni en la función ventricular preoperatoria entre los que desarrollaron BG o mantuvieron GC normal. Respecto a la administración de aprotinina o ácido tranexámico, el TNF-α al ingreso fue significativamente más elevado en quienes no recibieron estos fármacos que en los que habían recibido alguno (14,38 [6,22] frente a 8,77 [3,23] p < 0,01). Posteriormente los valores se equiparan entre ambos grupos. No hubo asociación entre el hecho de haber administrado estos fármacos y la presencia de BG.

Conclusiones

Los resultados confirman un incremento plasmático supranormal del TNF-α tras la CEC. Quienes desarrollan BG presentan unos valores significativamente más altos de TNF-α en plasma a las 24 horas de la CEC, implicando a esta citocina en la depresión miocárdica funcional post-CEC. La administración de aprotinina o ácido tranexámico se asoció a menores cifras de TNF-α en el postoperatorio inmediato, pero no previno la presentación de BG.

Palabras clave:
cirugía cardíaca
circulación extracorpórea
bajo gasto cardíaco
citocinas
interleucinas
TNF-α
Background

Extracorporeal circulation (EC) produces a systemic inflammatory response syndrome (SIRS), which is associated to low cardiac output (LCO), and is influenced by the activation of various proinflammatory and antiinflammatory cytokines.

Methods

Prospective study of 31 consecutive patients suffering from ischemic or valvular complaints, and operated on using EC, was made in order to establish whether a rise in plasmatic levels of TNF-α following EC (on arrival, after 4 hours and after 24 hours) is related to the appearance of LCO.

Results

Plasmatic levels of TNF-α could be analyzed in only 25 patients. Of these, 15 (60%) maintained a normal cardiac output, and 10 (40%) developed LCO. On arrival, TNF-α levels were significantly higher in the LCO group, whereas in the group showing normal cardiac output the levels returned to normal (12.79 [5.7] pg/ml vs. 7.52 [2.1] pg/ml; p < 0,05). There were not differences either regarding age or ventricular function between the patients with LCO and those with normal cardiac output. With regard to the administration of aprotinin or tranexamic acid, TNF-α levels on arrival were significantly higher in the patients who received neither of these drugs than in those who received one of them (14.38 [6.22] vs. 8.77 [3.23] p < 0.01). During the rest of the study, TNF-α plasmatic levels were similar in both groups. There was no relation between the administration of these drugs and LCO.

Conclusions

The results of this study confirm a greater-than-normal rise in plasmatic levels of TNF-α after EC. Those patients who develop LCO have significantly higher plasmatic levels of TNF- á 24 hours after EC, which suggests this cytokine is involved in depressed myocardial function following EC. The administration of aprotinin or tranexamic acid produced lower plasmatic levels of TNF-α in the immediate postoperative period, but did not prevent the LCO.

Key words:
cardiac surgery
cardiopulmonary bypass
extracorporeal circlation
stunt heart
low cardiac output
cytokines
TNF-α
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Copyright © 2000. Sociedad Española de Medicina Intensiva, Critica y Unidades Coronarias (SEMICYUC) and Elsevier España, S.L.
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