Braun Jan-Peter, Schroeder Torsten, Buehner Sabine, Jain Uday, Döpfmer Ulrich, Schuster Josephine, Bas Selcuk, Schimke Ingolf, Dohmen Pascal M, Lochs Herbert, Konertz Wolfgang, Spies Claudia
Departments of Anesthesiology and Intensive Care, Charité University Hospital, Charité-University Medicine Berlin, Germany.
Anesth Analg. 2006 Jan;102(1):17-24. doi: 10.1213/01.ane.0000184818.32635.fd.
Normothermic, nonpulsatile cardiopulmonary bypass (CPB) impairs systemic and splanchnic oxygen transport and increases gastrointestinal permeability. It is an important therapeutic goal to avoid splanchnic dysoxia during CPB. Small-dose prostacyclin therapy improves splanchnic oxygen transport and microcirculation in septic patients. In this study, we sought to determine if during cardiac surgery, the prostacyclin analog epoprostenol improves the balance of systemic and splanchnic oxygen transport. Eighteen patients undergoing cardiac valve replacement were randomized to receive either epoprostenol (3 ng x kg(-1) x min(-1)) or placebo during, and for 1 hour after, surgery. Systemic and splanchnic oxygen delivery, consumption, and extraction and arterial, mixed venous, and hepato-venous lactate concentrations were measured before, during, and after CPB. Gastrointestinal permeability was measured 1 day before and 1 day after surgery using the triple sugar permeability test. During CPB, the epoprostenol group had decreased systemic oxygen consumption and splanchnic oxygen extraction (P = 0.024). These effects were not present 1 hour after the end of epoprostenol infusion. The study was not adequately powered to determine whether epoprostenol altered the trend towards increased lactate metabolism and increased postoperative gastrointestinal permeability, nor could we demonstrate any differences between groups in clinically relevant end-points. In conclusion, these findings suggest that during normothermic CPB, small-dose epoprostenol therapy may reduce systemic oxygen consumption and splanchnic oxygen extraction.
常温、非搏动性体外循环（CPB）会损害全身和内脏的氧输送，并增加胃肠道通透性。避免CPB期间内脏缺氧是一个重要的治疗目标。小剂量前列环素治疗可改善脓毒症患者的内脏氧输送和微循环。在本研究中，我们试图确定在心脏手术期间，前列环素类似物依前列醇是否能改善全身和内脏氧输送的平衡。18例接受心脏瓣膜置换术的患者在手术期间及术后1小时被随机分为接受依前列醇（3 ng·kg⁻¹·min⁻¹）或安慰剂治疗。在CPB前、期间和之后测量全身和内脏的氧输送、消耗、摄取以及动脉血、混合静脉血和肝静脉血中的乳酸浓度。使用三糖通透性试验在手术前1天和手术后1天测量胃肠道通透性。在CPB期间，依前列醇组的全身氧消耗和内脏氧摄取降低（P = 0.024）。在依前列醇输注结束后1小时，这些效应不存在。该研究没有足够的效能来确定依前列醇是否改变了乳酸代谢增加和术后胃肠道通透性增加的趋势，我们也未能证明两组在临床相关终点上有任何差异。总之，这些发现表明，在常温CPB期间，小剂量依前列醇治疗可能会降低全身氧消耗和内脏氧摄取。
