Malmqvist Gunnar, Claesson Lingehall Helena, Appelblad Micael, Svenmarker Staffan
1 Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
2 Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden.
Perfusion. 2019 Mar;34(2):130-135. doi: 10.1177/0267659118793249. Epub 2018 Aug 16.
In the literature addressing cardiopulmonary bypass (CPB) prime composition, there is a considerable lack of discussion concerning plasma osmolality changes induced by using a hyperosmolar prime. With this study, we try to determine the magnitude and temporal relationship of plasma osmolality changes related to the use of a hyperosmolar CPB prime.
In this prospective observational study performed in a university hospital setting, we enrolled thirty patients scheduled for elective coronary bypass surgery. Plasma osmolality was analysed on eight occasions. A hyperosmolar CPB prime was used.
Analyses of the perioperative plasma osmolality on eight occasions gave the following results: the preoperative osmolality level was normal (297±4 mOsm/kg); a significant increase to 322±17 mOsm/kg (p<0.001) was observed at the commencement of CPB and remained elevated after 30 minutes (310±4 mOsm/kg) and throughout the procedure (309±4 mOsm/kg); the osmolality level returned to 291±5 mOsm/kg on day 1 postoperatively and remained normal the following day (291±6 mOsm/kg).
Use of hyperosmolar CPB prime resulted in a dramatic and instant elevation of the plasma osmolality. Rapid changes in plasma osmolality are associated with organ dysfunction (e.g. osmotic demyelination syndrome), therefore, effects on plasma osmolality related to the CPB prime composition should be recognised. Influence on organ function and clinical outcome warrants further investigations. - Clinical Trials.gov (NCT03060824). Changes in Plasma Osmolality Related to the Use of Cardiopulmonary Bypass With Hyperosmolar Prime. URL: https://clinicaltrials.gov/ct2/show/NCT03060824?term=cpb&cond=osmolality&rank=1.
在关于体外循环（CPB）预充液成分的文献中，对于使用高渗预充液引起的血浆渗透压变化，存在相当大的讨论缺失。通过本研究，我们试图确定与使用高渗CPB预充液相关的血浆渗透压变化的幅度和时间关系。
在一所大学医院进行的这项前瞻性观察研究中，我们纳入了30例计划进行择期冠状动脉搭桥手术的患者。在八个时间点分析血浆渗透压。使用了高渗CPB预充液。
对围手术期八个时间点的血浆渗透压分析得出以下结果：术前渗透压水平正常（297±4 mOsm/kg）；CPB开始时显著升高至322±17 mOsm/kg（p<0.001），30分钟后（310±4 mOsm/kg）及整个手术过程中（309±4 mOsm/kg）仍保持升高；术后第1天渗透压水平恢复至291±5 mOsm/kg，次日保持正常（291±6 mOsm/kg）。
使用高渗CPB预充液导致血浆渗透压急剧且即刻升高。血浆渗透压的快速变化与器官功能障碍（如渗透性脱髓鞘综合征）相关，因此，应认识到CPB预充液成分对血浆渗透压的影响。对器官功能和临床结局的影响值得进一步研究。 - 临床试验.gov（NCT03060824）。与使用高渗预充液的体外循环相关的血浆渗透压变化。网址：https://clinicaltrials.gov/ct2/show/NCT03060824?term=cpb&cond=osmolality&rank=1 。
