Gavrilovska-Brzanov Aleksandra, Shosholcheva Mirjana, Kuzmanovska Biljana, Kartalov Andrijan, Mojsova-Mijovska Maja, Jovanovski-Srceva Marija, Taleska Gordana, Brzanov Nikola, Simeonov Risto, Miceska Maja Slaninka
University Clinic for Traumatology, Orthopedic disease, Anesthesiology, Reanimation and Intensive Care Medicine and Emergency department, Faculty of Medicine, University "Ss. Cyril and Methodius", Skopje, R. Macedonia.
University Clinic for General Surgery "St. Naum Ohridski" Faculty of Medicine, University "Ss. Cyril and Methodius", Skopje, R. Macedonia.
Med Arch. 2017 Jun;71(3):178-182. doi: 10.5455/medarh.2017.71.178-182.
Surgery is supposed to modulate the production of carbon monoxide by the reduction of heme oxygenase activity or transcriptional regulation of inducible heme oxygenase. On the other hand, the inhalation of tobacco smoke can substantially raise the level of carboxyhemoglobin in the blood. Furthermore, methemoglobin is maintained at a constant level. However, excessive production of methemoglobin relative to total methemoglobin reductase activity results in methemoglobin increase.
The aim of our study was to investigate the perioperative variations of carboxyhemoglobin and methemoglobin during urologic surgeries, and at the same time to evaluate the changes in methemoglobin as a possible indicator of nitric oxide generation. Our second aim was to evaluate the effect of preoxygenation on the level of carboxyhemoglobin and methemoglobin and the influence of blood transfusion on their changes.
The study included 30 patients scheduled for urologic surgery under general endotracheal anesthesia, aged 18-60 years without any history of respiratory disease, divided into two groups. The study group comprised patients who were smoking cigarettes or tobacco pipe, while the control group included non-smokers. In both groups carboxyhemoglobin (COHb) and methemoglobin (MetHb) levels were determined preoperatively, after preoxygenation, and postoperatively.
COHb levels were decreased postoperatively in both groups. The average values of COHb between the two groups were statistically significantly different (p=0.00). MetHb levels increased postoperatively in the group of smokers and decreased in the group of non-smokers. There were no statistically significant differences in the average postoperative MetHb levels between the two groups.
Changes in carboxyhemoglobin and methemoglobin concentrations in arterial blood occur during urologic surgery, although these amplitudes are small when compared with carbon monoxide intoxication and methemoglobinemia. It is likely that organ perfusion and functions are affected by these monoxide gas mediators during urologic surgery.
手术旨在通过降低血红素加氧酶活性或对诱导型血红素加氧酶进行转录调控来调节一氧化碳的产生。另一方面，吸入烟草烟雾会大幅提高血液中碳氧血红蛋白的水平。此外，高铁血红蛋白维持在恒定水平。然而，相对于总高铁血红蛋白还原酶活性，高铁血红蛋白的过度产生会导致高铁血红蛋白增加。
我们研究的目的是调查泌尿外科手术期间碳氧血红蛋白和高铁血红蛋白的围手术期变化，同时评估高铁血红蛋白的变化作为一氧化氮生成的可能指标。我们的第二个目的是评估预充氧对碳氧血红蛋白和高铁血红蛋白水平的影响以及输血对其变化的影响。
该研究纳入了30例计划在全身气管内麻醉下进行泌尿外科手术的患者，年龄在18至60岁之间，无任何呼吸系统疾病史，分为两组。研究组包括吸烟或使用烟斗的患者，而对照组包括不吸烟者。在两组中，术前、预充氧后和术后均测定碳氧血红蛋白（COHb）和高铁血红蛋白（MetHb）水平。
两组术后COHb水平均降低。两组之间COHb的平均值在统计学上有显著差异（p = 0.00）。吸烟者组术后MetHb水平升高，不吸烟者组术后MetHb水平降低。两组术后MetHb平均水平在统计学上无显著差异。
泌尿外科手术期间动脉血中碳氧血红蛋白和高铁血红蛋白浓度会发生变化，尽管与一氧化碳中毒和高铁血红蛋白血症相比，这些变化幅度较小。在泌尿外科手术期间，这些一氧化碳气体介质可能会影响器官灌注和功能。
