J.Jpn. Surg. Soc.. 60(12): 1887-1910, 1960
EXPERIMENTAL AND CLINICAL STUDIES ON PROTEIN METABOLISM IN INTRACARDIAC SURGERY UNDER EXTRACORPOREAL CIRCULATION
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2nd Surgical Department, Tokyo University, School of Medicine (Director: Prof. Seizi Kimoto) Kazuhiko ATSUMI |
Furthermore, the influences of synthetic materials were discussed.
1) Preoperative liver and renal function were all in normal limits except a few cases, so the preoperative protein metabolism was considered not to have been disturbed by those liver or renal conditions.
2) The characteristic changes in these preoperative patients were hypoproteinemia (30%), hypoalbuminemia (50%) and slight hyper-β-globulinemia (all cases except one). All cases with pulmonary hypertension over 60 mmHg (systolic pressure) showed increase of serum α2-globulin.
3) Except protein reactions such as A/G ratio and Kunkel's test, postoperative disturbance of liver function recovered two weeks later, but protein reactions became abnormal at 2nd week and lasted until 2nd month.
So the changes of serum protein after 2nd postoperative week were considered to have been caused by hyperfunction of the reticuloendothelial system rather than liver damage.
4) Under extracorporeal circulation urine excretion was noted in arterial mean pressure of over 40 mmHg.
In moderate perfusion flow rate (40-60 cc/kg/min), no renal damage was noticed during perfusion, no difference of postoperative changes of renal function from that caused by general function from that caused by general surgical stress was noticed.
5) The long term follow-up study revealed that hypoproteinemia, hypoalbuminemia, hyper-α2-globulinemia and hypergammaglobulinemia were observed for a long period while hyper-β-globulinemia was noticed temporalily.
The author considered that hyper-β-globulinemia was due to hemolysis induced by pump-oxygenator and hypoalbuminemia as well as hyper-γ-globulinemia was presumably caused mostly by massive transfusion under extracorporeal circulation and the perfusion time.
The author investigated the relationship between hyper-γ-globulinemia and antibody production, but antibodies for donor's blood could not be proved by the author's method.
6) Low perfusion flow rate and prolonged perfusion time had influences on the protein metabolism and increased γ-globulin/Albumin ratio.
7) During usual perfusion, the problem of denaturation of serum protein induced by oxygenation with artificial lung was neglisible.
8) Hypoproteinemia under extracorporeal circulation was considered to have been caused by the dilution of heparinized blood in artificial heart-lung apparatus, furteer more it was related to bleeding, transfusion and peripheral circulatory insufficiency.
9) Hyper-γ-globulinemia was observed in the clinical cases of transplantation of synthetic materials.
Also by the animal experiments, hyper-γ-globulinemia was noticed in the mice in which the synthetic meterials were subcutaneously transplanted on abdominal wall. Inspite of injecting the powder of the identical synthetic materials into the peritoneal cavities of those mice with hyper-γ-glublinemia, no anaphylactic shock was observed. No antigen-antibody reaction could be proved by the author's method.
(author's abstract)
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