Holm Jonas, Szabó Zoltán, Alehagen Urban, Lindahl Tomas L, Cederholm Ingemar
Department of Cardiothoracic Surgery and Anesthesia and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Department of Cardiothoracic Surgery and Anesthesia and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
J Cardiothorac Vasc Anesth. 2018 Feb;32(1):245-250. doi: 10.1053/j.jvca.2017.06.011. Epub 2017 Jun 7.
To describe the dynamics of copeptin in open cardiac surgery during the perioperative course.
Prospective cohort study.
Single tertiary hospital.
Twenty patients scheduled for open cardiac surgery procedures with cardiopulmonary bypass (CPB).
No intervention.
Copeptin concentrations were measured pre-, peri-, and postoperatively until day 6 after surgery. Patients were analyzed as a whole cohort (n = 20) and in a restricted "normal cohort" consisting of patients with normal preoperative copeptin concentration (<10 pmol/L) and perioperative uneventful course (n = 11). In the whole cohort, preoperative copeptin concentration was 7.0 pmol/L (interquartile range: 3.1-11 pmol/L). All patients had an early rise of copeptin, with 80% having peak copeptin concentration at weaning from CPB or upon arrival in the intensive care unit. Patients in the "normal cohort" had copeptin concentration at weaning from CPB of 194 pmol/L (98-275), postoperative day 1, 27 pmol/L (18-31); and day 3, 8.9 pmol/L (6.3-12).
Regardless of cardiac surgical procedure and perioperative course, all patients had an early significant rise of copeptin concentrations, generally peaking at weaning from CBP or upon arrival in the intensive care unit. Among patients with normal copeptin concentration preoperatively and uneventful course, the postoperative copeptin concentrations decreased to normal values within 3-to-4 days after cardiac surgery. Furthermore, the restricted "normal cohort" generally tended to display lower levels of copeptin concentration postoperatively. Further studies may evaluate whether copeptin can be a tool in identifying risk patients in cardiac surgery.
描述围手术期开胸心脏手术中 copeptin 的动态变化。
前瞻性队列研究。
单一的三级医院。
20 例计划进行体外循环（CPB）下开胸心脏手术的患者。
无干预。
在术前、术中及术后直至术后第 6 天测量 copeptin 浓度。对患者作为一个整体队列（n = 20）以及一个受限的“正常队列”进行分析，“正常队列”由术前 copeptin 浓度正常（<10 pmol/L）且围手术期过程平稳的患者组成（n = 11）。在整个队列中，术前 copeptin 浓度为 7.0 pmol/L（四分位间距：3.1 - 11 pmol/L）。所有患者的 copeptin 均早期升高，80%的患者在 CPB 脱机时或进入重症监护病房时 copeptin 浓度达到峰值。“正常队列”患者在 CPB 脱机时 copeptin 浓度为 194 pmol/L（98 - 275），术后第 1 天为 27 pmol/L（18 - 31）；术后第 3 天为 8.9 pmol/L（6.3 - 12）。
无论心脏手术方式及围手术期过程如何，所有患者的 copeptin 浓度均早期显著升高，通常在 CPB 脱机时或进入重症监护病房时达到峰值。在术前 copeptin 浓度正常且过程平稳的患者中，心脏手术后 copeptin 浓度在 3 至 4 天内降至正常水平。此外，受限的“正常队列”术后 copeptin 浓度通常趋于较低水平。进一步的研究可评估 copeptin 是否能作为识别心脏手术风险患者的一种工具。
