Kano Hiroya, Takahashi Hiroaki, Inoue Takeshi, Tanaka Hiroshi, Okita Yutaka
1 Clinical Engineering, Akashi Medical Center, Akashi, Japan.
2 Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Perfusion. 2017 Apr;32(3):200-205. doi: 10.1177/0267659116667807. Epub 2016 Oct 22.
Intestinal fatty acid-binding protein (I-FABP) is increasingly employed as a highly specific marker of intestinal necrosis. However, the value of this marker associated with cardiovascular surgery with hypothermic circulatory arrest is unclear. The aim of this study was to measure serum I-FABP levels and provide the transition of I-FABP levels with hypothermic circulatory arrest to help in the management of intestinal perfusion.
From August 2011 to September 2013, 33 consecutive patients who had aortic arch surgery with hypothermic circulatory arrest or heart valve surgery performed were enrolled in the study. Twenty patients had aortic surgery with hypothermic (23-29°C) circulatory arrest and 13 patients had heart valve surgery with cardiopulmonary bypass (33°C).
I-FABP levels increased, both in patients undergoing aortic surgery with hypothermic circulatory arrest and heart valve surgery with cardiopulmonary bypass, reaching peak levels shortly after the administration of protamine. I-FABP levels in patients with aortic surgery were significantly higher with circulatory arrest. They reached peak levels immediately after recirculation and there was a significant drop at the end of surgery (p<0.001). I-FABP levels in heart valve surgery were gradually increased, with the highest at the administration of protamine; they gradually decreased. Peak I-FABP levels were significantly higher in patients undergoing aortic surgery with hypothermic circulatory arrest than in patients with heart valve surgery. However, no postoperative reperfusion injury occurred in the intestinal tract due to the use of hypothermic organ protection.
Plasma I-FABP monitoring could be a valuable method for finding an intestinal ischemia in patients with cardiovascular surgery.
肠脂肪酸结合蛋白（I-FABP）越来越多地被用作肠坏死的高度特异性标志物。然而，该标志物在低温循环骤停心血管手术中的价值尚不清楚。本研究的目的是测量血清I-FABP水平，并提供低温循环骤停时I-FABP水平的变化情况，以帮助肠道灌注的管理。
2011年8月至2013年9月，连续纳入33例接受低温循环骤停主动脉弓手术或心脏瓣膜手术的患者。20例患者接受低温（23-29°C）循环骤停主动脉手术，13例患者接受体外循环心脏瓣膜手术（33°C）。
接受低温循环骤停主动脉手术和体外循环心脏瓣膜手术的患者，I-FABP水平均升高，在给予鱼精蛋白后不久达到峰值。主动脉手术患者的I-FABP水平在循环骤停时显著更高。再循环后立即达到峰值，手术结束时显著下降（p<0.001）。心脏瓣膜手术患者的I-FABP水平逐渐升高，在给予鱼精蛋白时最高；随后逐渐下降。低温循环骤停主动脉手术患者的I-FABP峰值水平显著高于心脏瓣膜手术患者。然而，由于采用低温器官保护，术后肠道未发生再灌注损伤。
血浆I-FABP监测可能是发现心血管手术患者肠道缺血的一种有价值的方法。
