Masai T, Taniguchi K, Kuki S, Endo S, Yoshida K, Yamamoto K, Matsuda H
Department of Cardiovascular Surgery, Labor Welfare Corporation Osaka Rosai Hospital, Sakai, Japan.
ASAIO J. 2001 Sep-Oct;47(5):548-51. doi: 10.1097/00002480-200109000-00030.
Selective cerebral perfusion (SCP) and open distal anastomosis (OD) with hypothermia has been used as a popular means for circulatory assistance in aortic arch surgery. Although SCP has become accepted for brain protection, the influence of OD accompanying circulatory arrest on lower body ischemia is not known. We studied gastric tonometry (gastric intramucosal pH [pHi]) to estimate splanchnic ischemia during OD, and its relationship to postoperative organ function. In five patients (pts) (range, 65-78 years; mean, 71 years; group OD) who underwent arch replacement using SCP and OD with moderate hypothermia (25 degrees C) during the period from March to August of 1999, pHi was measured precardiopulmonary bypass (pre-CPB), 30 min of CPB (CPB30), 10 min after OD (OD10), at end of CPB, and post-CPB. Eight pts (range, 52-78 years; mean; 66 years) who underwent standard CPB (33 degrees C) during the same period (coronary artery bypass surgery in six and valve surgery in two) served as controls (group C). In group OD, pHi was significantly decreased at OD10 (7.35 +/- 0.03 at CPB30 vs. 7.23 +/- 0.07 at OD10, p < 0.05) but recovered by the end of CPB (7.32 +/- 0.02). Creatinine clearance on the first postoperative day (1POD) was significantly (p < 0.05) lower in group OD (82 +/- 40 ml/min) than in group C (126 +/- 25 ml/min), although there was no significant difference in preoperative values between the two groups. The pHi at OD10 did not correlate with the duration of OD (range, 30-47 min; mean, 38 min), whereas pHi at OD10 significantly correlated with BUN (r = -0.973, p = 0.0054), Cr(r = -0.977, p = 0.0043), and CCr (r = 0.908, p = 0.0328) on 1POD. One patient in group OD developed paraplegia and renal failure postoperatively. His pHi at OD10 was severely decreased to 7.11. These results suggest that intraoperative monitoring of pHi may be useful for the evaluation of visceral organ ischemia during OD in arch replacement and may contribute to improved technique for circulatory assistance in aortic surgery.
选择性脑灌注（SCP）联合低温下的开放远端吻合术（OD）已成为主动脉弓手术中常用的循环辅助手段。尽管SCP已被认可用于脑保护，但伴随循环停止的OD对下半身缺血的影响尚不清楚。我们研究了胃张力测定法（胃黏膜内pH值[pHi]）以评估OD期间的内脏缺血情况及其与术后器官功能的关系。在1999年3月至8月期间，对5例患者（pts）（年龄范围65 - 78岁；平均71岁；OD组）进行了使用SCP和OD并中度低温（25℃）的主动脉弓置换术，在体外循环前（CPB前）、CPB 30分钟（CPB30）、OD后10分钟（OD10）、CPB结束时及CPB后测量pHi。同期8例患者（年龄范围52 - 78岁；平均66岁）进行了标准CPB（33℃）（6例冠状动脉搭桥手术，2例瓣膜手术）作为对照组（C组）。在OD组，pHi在OD10时显著降低（CPB30时为7.35±0.03，OD10时为7.23±0.07，p < 0.05），但在CPB结束时恢复（7.32±0.02）。OD组术后第1天（1POD）的肌酐清除率（82±40 ml/min）显著低于C组（126±25 ml/min）（p < 0.05），尽管两组术前值无显著差异。OD10时的pHi与OD持续时间（范围30 - 47分钟；平均38分钟）无关，而OD10时的pHi与1POD时的血尿素氮（r = -0.973，p = 0.0054）、肌酐（r = -0.977，p = 0.0043）和肌酐清除率（r = 0.908，p = 0.0328）显著相关。OD组有1例患者术后发生截瘫和肾衰竭。其OD10时的pHi严重降低至7.11。这些结果表明，术中监测pHi可能有助于评估主动脉弓置换术中OD期间的内脏器官缺血情况，并可能有助于改进主动脉手术中的循环辅助技术。
