Author/Editor		Grosek, Štefan
Title		Vpliv zunajtelesnega krvnega obtoka na sistemski vnetni odziv, na limfocitne populacije v krvi in na srčno funkcijo pri otrocih, operiranih na odprtem srcu
Type		monografija
Place		Ljubljana
Publisher		Univerza v Ljubljani, Medicinska fakulteta
Publication year		2006
Volume		str. 104
Language		slo
Abstract		Background. Cardiopulmonary bypass (CPB) during open-heart surgery activates the systemic inflammatory and immune response and negatively affects cardiac function, which is reflected in a decrease in the cardiac output. The systemic inflammatory response comprises proinflammatory and antiinflammatory mediators. Among the proinflammatory cytokines, tumor necrosis factor-alpha (TNF-alpha) damages the myocardium and has a negative effect on cardiac function, while the antiinflammatory cytokine, interleukin-10 (IL-10), protects against myocardial damage and positively affects cardiac function. Changes in the immune response are also seen in T-lymphocytes (T CD3+) and monocytes/macrophages. Low concentrations of T-lymphocytes (T CD3+) and T-helper cells (T CD4+) are found, together with changes in the function of T-helper cells (T CD4+). In monocytes/macrophages these changes are manifest as a decreased expression of HLA-DR+ membrane molecules (monocyte deactivation). High-dose methylprednisolone increases the concentration of IL-10 and changes lymphocyte trafficking in the blood. Current research into patients operated on using CPB who received methylprednisolone established an increased release of IL-10 and a decreased concentration of T-lymphocytes (T CD3+) in the blood, but no proven effect on cardiac function was found. The objectives of the study. The aim of the research was to follow cardiac function using the PiCCO method and to establish whether a transient low cardiac output developed in the first 24 hours after operation under CPB. In addition it was our aim to determine whether there existed within a homogenous group of children subgroups who developed either lower or higher cardiac output (low- and high CI-group) and whether these two subgroups of children differ in concentrations of TNF-alpha, IL-10 and lymphocyte, monocyte and granulocyte populations. (Abstract truncated at 2000 charactes)
Descriptors		EXTRACORPOREAL CIRCULATION CARDIAC OUTPUT TUMOR NECROSIS FACTOR INTERLEUKIN-10 METHYLPREDNISOLONE CHILD THERMODILUTION CARDIAC OUTPUT, LOW HEART RATE TROPONIN I ECHOCARDIOGRAPHY CD4 LYMPHOCYTE COUNT HLA-DR ANTIGENS T-LYMPHOCYTE SUBSETS PROSPECTIVE STUDIES