Durán Bruce M, Gomar Sancho C, Holguera J C, Muliterno Español E
Servicio de Anestesiología, Hospital San Borja Arriarán, Santiago de Chile, Chile.
Servicio de Anestesiología, Hospital Clínic, Barcelona, España.
Rev Esp Anestesiol Reanim. 2014 May;61(5):246-53. doi: 10.1016/j.redar.2013.11.015. Epub 2014 Feb 5.
The incidence and risk factors for vasoplegia in the early postoperative period and at 24h are investigated in patients subjected to cardiopulmonary bypass surgery. Vasoplegia following cardiac surgery with cardiopulmonary bypass is associated with a high morbimortality. The risk factors described emerged from retrospective, non-controlled studies.
Observational prospective study of 188 consecutive patients subjected to cardiac surgery with cardiopulmonary bypass in a single hospital between November 2011 and May 2012. Emergency surgery or complex procedures were excluded. Vasoplegia was assessed during the immediate postoperative period, and at 24h after surgery, and was defined as a mean arterial pressure below 50mmHg, and the need for a noradrenaline perfusion of more than 0.08μg/kg/min, monitored by cardiac output and systemic vascular resistances. The anaesthetic and cardiopulmonary bypass protocols, as well as haemodynamic management, were the same in all patients.
Almost half (48%) of patients had vasoplegia in the immediate postoperative period, and 34% at 24h. Risk factors for immediate vasoplegia development were preoperative use of angiotensin converting enzyme inhibitor drugs, a mean arterial pressure<50mmHg immediately after beginning cardiopulmonary bypass, duration of aortic clamping as well as the cardiopulmonary bypass, and minimum temperature in cardiopulmonary bypass. Vasoplegia at 24h after surgery was correlated to preoperative angiotensin converting enzyme inhibitor drug treatment and cardiopulmonary bypass duration.
The incidence of vasoplegia after cardiac surgery with cardiopulmonary bypass is high during the first 24 postoperative hours. Preoperative treatment with angiotensin converting enzyme inhibitor and the mean arterial pressure at the beginning of cardiopulmonary bypass are the more easily controllable risk factors. In patients arriving to surgery with those drugs, treatment or prevention of vasoplejia should be planned.
对接受体外循环手术的患者术后早期及术后24小时血管麻痹的发生率和危险因素进行研究。体外循环心脏手术后的血管麻痹与高病死率相关。已描述的危险因素来自回顾性、非对照研究。
对2011年11月至2012年5月期间在一家医院连续接受体外循环心脏手术的188例患者进行前瞻性观察研究。排除急诊手术或复杂手术。在术后即刻及术后24小时评估血管麻痹情况，定义为平均动脉压低于50mmHg，且需要去甲肾上腺素灌注量超过0.08μg/kg/min，并通过心输出量和全身血管阻力进行监测。所有患者的麻醉和体外循环方案以及血流动力学管理均相同。
几乎一半（48%）的患者在术后即刻出现血管麻痹，24小时时为34%。术后即刻发生血管麻痹的危险因素包括术前使用血管紧张素转换酶抑制剂药物、体外循环开始后即刻平均动脉压<50mmHg、主动脉阻断时间以及体外循环时间，还有体外循环最低温度。术后24小时的血管麻痹与术前血管紧张素转换酶抑制剂药物治疗及体外循环时间相关。
体外循环心脏手术后血管麻痹在术后最初24小时内发生率较高。术前使用血管紧张素转换酶抑制剂治疗以及体外循环开始时的平均动脉压是较易控制的危险因素。对于术前使用这些药物的手术患者，应规划血管麻痹的治疗或预防措施。
