Mand'ák J, Zivný P, Lonský V, Palicka V, Kakrdová D, Marsíková M, Kunes P, Kubícek J
Department of Cardiac Surgery, Charles University Hospital, Hradec Králové, Czech Republic.
Perfusion. 2004 Jan;19(1):53-63. doi: 10.1191/0267659104pf704oa.
The aim of this study was to monitor the metabolism and blood flow in the interstitium of the skeletal muscle during cardiac surgery with cardiopulmonary bypass (CPB) and in the early postoperative period by means of microdialysis and to compare metabolic changes during CPB at normothermia (NT) and hypothermia (HT). Surgical revascularization using CPB was performed in 50 patients, 25 patients (group HT) were operated using hypothermic CPB, 25 (group NT) using normothermic CPB. Interstitial microdialysis was performed by two CMA 60 probes (CMA Microdialysis AB, Solna, Sweden) inserted into the patient's deltoid muscle. Constituents analysed in the obtained dialysates, collected at intervals, were glucose, urea, glycerol and lactate. Tissue blood flow was monitored by dynamic microdialysis with gentamicin as a marker. In both groups, NT versus HT, similar dynamics of concentrations were found. Low initial concentrations were followed by gradual increases during CPB and in the following phase of the operation. Concentrations were higher in the NT group. Immediately after the operation, the decrease in values continued, with a gradual increase in the succeeding postoperative period in both groups. Similar dynamic changes in the lactate concentration were found in both groups. The gentamicin concentrations were lower in the NT group (versus the HT group). The results showed dynamic changes in the interstitial concentrations of glucose, urea, glycerol and lactate, which depend on the phase of the surgery in the CPB and early postoperative phase in the both groups of patients. Higher tissue perfusion of the skeletal muscle was noted in those patients operated on in normothermia. The dynamics of the concentration changes of these substances in the interstitium of the skeletal muscle has been proven to be caused by both the metabolic activity of the tissue and by the blood flow through the interstitium of the muscle.
本研究旨在通过微透析监测体外循环（CPB）心脏手术期间及术后早期骨骼肌间质的代谢和血流情况，并比较常温（NT）和低温（HT）CPB期间的代谢变化。50例患者接受了使用CPB的外科血管重建术，其中25例患者（HT组）采用低温CPB进行手术，25例（NT组）采用常温CPB进行手术。通过插入患者三角肌的两根CMA 60探针（瑞典索尔纳的CMA微透析公司）进行间质微透析。对每隔一段时间收集的透析液中分析的成分包括葡萄糖、尿素、甘油和乳酸。以庆大霉素为标记物，通过动态微透析监测组织血流。在NT组和HT组中，发现了相似的浓度变化动态。初始浓度较低，随后在CPB期间及手术的后续阶段逐渐升高。NT组的浓度较高。手术后立即，数值持续下降，两组在术后后续阶段均逐渐升高。两组中乳酸浓度均发现了相似的动态变化。NT组的庆大霉素浓度较低（与HT组相比）。结果显示，葡萄糖、尿素、甘油和乳酸的间质浓度存在动态变化，这取决于CPB手术阶段及两组患者术后早期阶段。在接受常温手术的患者中，注意到骨骼肌的组织灌注较高。已证明骨骼肌间质中这些物质浓度变化的动态是由组织的代谢活性以及通过肌肉间质的血流共同引起的。
