Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
J Clin Biochem Nutr. 2011 Jul;49(1):16-9. doi: 10.3164/jcbn.10-101. Epub 2011 Apr 26.
Major physiological stress occurs during cardiac surgery with cardiopulmonary bypass. This is related to hypothermia and artificial organ perfusion. Thus, serious gastrointestinal complications, particularly upper gastrointestinal bleeding, sometimes follow cardiac surgery. We have compared the antisecretory effects of a preanesthetic H(2) antagonist (roxatidine, cardiopulmonary bypass-H(2) group, n = 15) and a proton pump inhibitor (rabeprazole, cardiopulmonary bypass-PPI group, n = 15) in patients undergoing cardiac surgery with cardiopulmonary bypass, and also compared in patients undergoing a off-pump coronary artery bypass graft surgery (off-pump cardiopulmonary bypass-H(2) group, n = 15). Gastric pH (5.14 ± 0.61) and gastric fluid volume (13.2 ± 2.4 mL) at the end of surgery in off-pump cardiopulmonary bypass-H(2) groups was significantly lower and higher than those in both cardiopulmonary bypass-H(2) (6.25 ± 0.54, 51.3 ± 8.0 mL) and cardiopulmonary bypass-PPI (7.29 ± 0.13, 63.5 ± 14.8 mL) groups, respectively although those variables did not differ between groups after the induction of anesthesia. Plasma gastrin (142 ± 7 pg/mL) at the end of surgery and maximal blood lactate levels (1.50 ± 0.61 mM) in off-pump cardiopulmonary bypass-H(2) group were also significantly lower than those in both cardiopulmonary bypass-H(2) (455 ± 96 pg/mL, 3.97 ± 0.80 mM) and cardiopulmonary bypass-PPI (525 ± 27 pg/mL, 3.15 ± 0.44 mM) groups, respectively. In addition, there was a significant correlation between gastric fluid volume and maximal blood lactate (r = 0.596). In conclusion, cardiopulmonary bypass may cause an increase in gastric fluid volume which neither H(2) antagonist nor PPI suppresses. A significant correlation between gastric fluid volume and maximal blood lactate suggests that gastric fluid volume may predict degree of gastrointestinal tract hypoperfusion.
在体外循环心脏手术期间会发生主要的生理应激。这与低温和人工器官灌注有关。因此，心脏手术后常出现严重的胃肠道并发症，特别是上消化道出血。我们比较了体外循环前麻醉 H₂ 拮抗剂（罗沙替丁，体外循环-H₂ 组，n=15）和质子泵抑制剂（雷贝拉唑，体外循环-PPI 组，n=15）在体外循环心脏手术患者中的抗分泌作用，并比较了非体外循环冠状动脉旁路移植术（非体外循环心脏旁路-H₂ 组，n=15）患者中的作用。非体外循环心脏旁路-H₂ 组的手术结束时的胃 pH 值（5.14±0.61）和胃液量（13.2±2.4mL）明显低于体外循环-H₂ 组（6.25±0.54，51.3±8.0mL）和体外循环-PPI 组（7.29±0.13，63.5±14.8mL），尽管麻醉诱导后这些变量在各组之间没有差异。非体外循环心脏旁路-H₂ 组的手术结束时的血浆胃泌素（142±7pg/mL）和最大血乳酸水平（1.50±0.61mM）也明显低于体外循环-H₂ 组（455±96pg/mL，3.97±0.80mM）和体外循环-PPI 组（525±27pg/mL，3.15±0.44mM）。此外，胃液量与最大血乳酸之间存在显著相关性（r=0.596）。总之，体外循环可能导致胃液量增加，H₂ 拮抗剂和 PPI 均不能抑制。胃液量与最大血乳酸之间存在显著相关性表明，胃液量可能预测胃肠道低灌注的程度。
