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 investigage the effect of a single dose of prebypass
corticosteroid on pulmonary leukostasis and postoperative pulmonary dysfunction. The study was performed prospectively in randomized-blind fashion 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 30mg/kg)was injected prior to CPB and in the placebo group(n=25), normal saline was injected before CPB.
@ES The results were summarized as follows.
@EN 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 dya.
2. During partial CPB, transpulmoary 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(ICU) and the lymphocytopenia remained until postoperative 3rd day. The lymphocyte counts recovered on postoperative 7th
day.
4. In both groups, peripheral counts of monocyte were relatively stable in the early 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 PaO2 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).
We concluded that leukocyte activation and transpulmonary sequestration of leukocyte are caused by CPB and it is also noticed that administration of high dose corticosteroid before CPB is beneficial for the prevention of transpulmonary
sequestration of
leukocyte.
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