Tabata R, Mori A, Watarida S, Onoe M, Shiraishi S, Nojima T, Matsuno S
Department of Second Surgery, Shiga University of Medical Science, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1992 Jan;40(1):6-12.
In patients undergoing open heart surgery, we assessed the effect of prostaglandin E1 (PGE1) treatment, 0.1 micrograms/min/kg dosage, during extracorporeal circulation. This treatment resulted in a marked perfusion pressure reduction. As a result, PGE1-treated group showed less urine volume than untreated control group. However, the degree of urine volume reduction relative to the decrease in blood pressure was less in PGE1-treated group than in untreated control group, suggesting a diuretic action of PGE1. We infer from these results that renal blood flow was maintained even after PGE1-induced intense perfusion pressure reduction, allowing for avoidance of renal impairment during extracorporeal circulation. In PGE1-treated adults, recovery of rectal temperature after hypothermic extracorporeal circulation was poorer but that of muscle temperature was better than in untreated adults. This phenomenon can be interpreted as representing improvement of blood-mediated heat transfer from deep regions of trunk to muscles and superficial skin due to PGE1-induced improvement of peripheral circulation. The ameliorative effect of PGE1 on peripheral circulation during extracorporeal circulation was further confirmed by the fact that the amount of NaHCO3 required for correction of metabolic acidosis was significantly lower in PGE1-treated group than in untreated control group. These results indicate that PGE1 treatment during extracorporeal circulation makes body temperature control easier, favorably affects postoperative body temperature recovery and improves peripheral tissue metabolism.
在接受心脏直视手术的患者中,我们评估了体外循环期间前列腺素E1(PGE1)治疗(剂量为0.1微克/分钟/千克)的效果。这种治疗导致灌注压显著降低。结果,PGE1治疗组的尿量比未治疗的对照组少。然而,PGE1治疗组相对于血压下降的尿量减少程度比未治疗的对照组小,这表明PGE1具有利尿作用。我们从这些结果推断,即使在PGE1导致强烈的灌注压降低后,肾血流量仍得以维持,从而避免了体外循环期间的肾功能损害。在接受PGE1治疗的成年人中,低温体外循环后直肠温度的恢复较差,但肌肉温度的恢复比未治疗的成年人好。这种现象可以解释为,由于PGE1引起的外周循环改善,血液介导的热量从躯干深部区域向肌肉和体表皮肤的传递得到了改善。PGE1治疗组纠正代谢性酸中毒所需的NaHCO3量显著低于未治疗的对照组,这一事实进一步证实了PGE1在体外循环期间对外周循环的改善作用。这些结果表明,体外循环期间的PGE1治疗使体温控制更容易,对术后体温恢复产生有利影响,并改善外周组织代谢。