常温体外循环后的内脏氧输送、肝功能及胃肠道屏障

Splanchnic oxygen transport, hepatic function and gastrointestinal barrier after normothermic cardiopulmonary bypass.

作者信息

Braun J P, Schroeder T, Buehner S, Dohmen P, Moshirzadeh M, Grosse J, Streit F, Schlaefke A, Armstrong V W, Oellerich M, Lochs H, Konertz W, Kox W J, Spies C

机构信息

Department of Anesthesiology and Intensive Care, University Hospital Charité, Humboldt University, Berlin, Germany.

出版信息

Acta Anaesthesiol Scand. 2004 Jul;48(6):697-703. doi: 10.1111/j.1399-6576.2004.00392.x.

DOI:10.1111/j.1399-6576.2004.00392.x

PMID:15196101

Abstract

BACKGROUND

The effect of non-pulsatile, normothermic cardiopulmonary-bypass (CPB) on the splanchnic blood-flow and oxygen-transport, the hepatic function and the gastrointestinal barrier were observed in a prospective observational study in 31 adults undergoing cardiac valve replacement surgery.

METHODS

The splanchnic (i.e. hepatic) blood-flow (HBF) was measured by the constant infusion of indocyanine-green (ICG) using a hepatic-venous catheter. Liver function was examined by calculation of lactate uptake, ICG extraction and the monoethylglycinexylidide (MEGX) test. A day before and after surgery the gastrioduodenal and intestinal permeability was measured by determination of sucrose and lactulose/mannitol excretion.

RESULTS

Splanchnic blood flow and oxygen delivery did not decrease during and after surgery while splanchnic oxygen consumption (P < 0.0125) and arterial lactate concentrations increased. The splanchnic lactate uptake paralleled the lactate concentration. After but not during CPB an increase of systemic oxygen consumption was observed. The MEGX test values decreased on the first day after surgery. The ICG extraction was attenuated during the operation. The gastroduodenal and the intestinal permeability increased significantly postoperatively (P < 0.002, respectively, P < 0.001). There was no correlation between these findings and the duration of CPB. There was a significant correlation of the intestinal permeability but not of the gastroduodenal permeability between the prior and after surgery values (P < 0.001).

CONCLUSION

Increased oxygen consumption during CPB may indicate an inflammatory reaction due to the pump beginning in the splanchnic area or a redistribution of the splanchinc blood flow during the CPB. Normothermic CPB does not lead to a significant or prolonged reduction of liver function. Normothermic CPB causes an increase of gastrointestinal permeability. The intestinal barrier function prior to surgery was accountable for the degree of loss of intestinal barrier function following surgery.

摘要

背景

在一项前瞻性观察研究中，对31例接受心脏瓣膜置换手术的成人患者观察了非搏动性常温体外循环（CPB）对内脏血流和氧运输、肝功能及胃肠道屏障的影响。

方法

采用肝静脉导管持续输注吲哚菁绿（ICG）来测量内脏（即肝脏）血流（HBF）。通过计算乳酸摄取、ICG清除率和单乙基甘氨酰二甲苯胺（MEGX）试验来检测肝功能。在手术前后一天，通过测定蔗糖及乳果糖/甘露醇排泄量来测量胃十二指肠和肠道通透性。

结果

手术期间及术后内脏血流和氧输送未减少，而内脏氧耗量（P < 0.0125）和动脉血乳酸浓度增加。内脏乳酸摄取与乳酸浓度平行。在CPB后而非CPB期间观察到全身氧耗量增加。术后第一天MEGX试验值降低。手术期间ICG清除率降低。术后胃十二指肠和肠道通透性显著增加（分别为P < 0.002，P < 0.001）。这些结果与CPB持续时间之间无相关性。手术前后肠道通透性值之间存在显著相关性，但胃十二指肠通透性无相关性（P < 0.001）。