Lenkin Andrey I, Zaharov Viktor I, Lenkin Pavel I, Smetkin Alexey A, Bjertnaes Lars J, Kirov Mikhail Y
Department of Anesthesiology and Intensive Care Medicine, City Hospital #1 of Arkhangelsk, Arkhangelsk, Russian Federation.
Interact Cardiovasc Thorac Surg. 2013 May;16(5):595-601. doi: 10.1093/icvts/ivt016. Epub 2013 Feb 13.
In cardiac surgery, the choice of temperature regimen during cardiopulmonary bypass (CPB) remains a subject of debate. Hypothermia reduces tissue metabolic demands, but may impair the autoregulation of cerebral blood flow and contribute to neurological morbidity. The aim of this study was to evaluate the effect of two different temperature regimens during CPB on the systemic oxygen transport and the cerebral oxygenation during surgical correction of acquired heart diseases.
In a prospective study, we randomized 40 adult patients with combined valvular disorders requiring surgical correction of two or more valves into two groups: (i) a normothermic (NMTH) group (n = 20), in which the body core temperature was maintained at 36.6°C during CPB and (ii) a hypothermic (HPTH) group (n = 20), in which the body was cooled to a core temperature of 32°C maintained throughout the period of CPB. The systemic oxygen transport and the cerebral oxygen saturation (SctO2) were assessed by means of a PiCCO2 haemodynamic monitor and a cerebral oximeter, respectively. All the patients received standard perioperative monitoring. We assessed haemodynamic and oxygen transport parameters, the duration of mechanical ventilation and the length of the ICU and the hospital stays.
During CPB, central venous oxygen saturation was significantly higher in the HPTH group but SctO2 was increased in the NMTH group (P < 0.05). Cardiac index, systemic oxygen delivery and consumption increased postoperatively in both groups. However, oxygen delivery and consumption were significantly higher in the NMTH group (P < 0.05). The duration of respiratory support and the length of ICU and hospital stays did not differ between the groups.
During combined valve surgery, normothermic CPB provides lower central venous oxygen saturation, but increases cerebral tissue oxygenation when compared with the hypothermic regimen.
在心脏手术中，体外循环（CPB）期间温度方案的选择仍是一个有争议的话题。低温可降低组织代谢需求，但可能损害脑血流的自动调节并导致神经并发症。本研究的目的是评估CPB期间两种不同温度方案对后天性心脏病手术矫正期间全身氧输送和脑氧合的影响。
在一项前瞻性研究中，我们将40例需要手术矫正两个或更多瓣膜的成年瓣膜疾病合并患者随机分为两组：（i）常温（NMTH）组（n = 20），CPB期间核心体温维持在36.6°C；（ii）低温（HPTH）组（n = 20），在整个CPB期间将身体冷却至核心体温32°C。分别通过PiCCO2血流动力学监测仪和脑氧饱和度仪评估全身氧输送和脑氧饱和度（SctO2）。所有患者均接受标准的围手术期监测。我们评估了血流动力学和氧输送参数、机械通气时间、ICU住院时间和住院时间。
CPB期间，HPTH组中心静脉血氧饱和度显著更高，但NMTH组SctO2升高（P < 0.05）。两组术后心脏指数、全身氧输送和氧消耗均增加。然而，NMTH组的氧输送和氧消耗显著更高（P < 0.05）。两组之间呼吸支持时间、ICU住院时间和住院时间无差异。
在联合瓣膜手术期间，与低温方案相比，常温CPB可降低中心静脉血氧饱和度，但可增加脑组织氧合。
