Boekstegers P, Fleckenstein W, Rosport A, Ruschewsky W, Braun U
Institut für Physiologie, Medizinischen Universität zu Lübeck.
Anaesthesist. 1988 May;37(5):287-96.
In patients undergoing aortocoronary bypass operations, extensive monitoring is used for early recognition of complications that may decrease the oxygen supply of body organs. However, none of the parameters usually monitored during open-heart surgery yield information on the state of oxygen supply to a certain organ. Particularly during and after extracorporeal circulation (ECC), undetected organ hypoxia may occur and lead to an increase in postoperative complications. In order to study whether functionally significant changes in oxygen supply to skeletal muscle occur during extracorporeal circulation, in 14 patients undergoing aortocoronary bypass operations pO2 histograms from local pO2 values in resting skeletal muscle were monitored. Intra- and postoperatively, whole-body oxygen uptake (VO2) and pO2 histograms of skeletal muscle were simultaneously measured to determine whether the observed decrease in VO2 during cooling of the patient or the increase in VO2 during rewarming was reflected in the distribution of tissue pO2 in skeletal muscle. PATIENTS AND METHODS. Fourteen patients (aged 42 to 68; 12 male, 2 female) scheduled for 2-4 aortocoronary venous bypass grafts were studied. Measuring periods of 6 min were undertaken after induction of anesthesia (1), after thoracotomy (2), during ECC (3), after ECC (2), and every hour postoperatively up to 5 h. The following data were measured during each period: pO2 histograms of the biceps brachii muscle using a pO2 histograph VO2 using open indirect calorimetry; arterial (a. radialis) and venous (v. cava superior) blood gases, acid-base balances, and blood pressures; venous lactate (v. cava superior); muscle and rectal temperatures. RESULTS. During ECC mean muscle pO2 in all 14 patients decreased from 25 to 14 mmHg. In 7 of 14 patients pO2 values between 0 and 5 mmHg had the highest incidence (left-shifted pO2 histograms). After ECC mean muscle pO2 increased to the same value observed before ECC (25 mmHg). During the first 3 h postoperatively an intermediate decrease in mean muscle pO2 (range 23%-46%) occurred in each patient. Stable values above 20 mmHg were reattained 4 h postoperatively. The postoperative increase in individual VO2 was correlated to the increase in body temperature (r = 0.84); in 5 patients with severe shivering, VO2 was markedly increased (up to 130% compared to the last intraoperative value).(ABSTRACT TRUNCATED AT 400 WORDS)
在接受主动脉冠状动脉搭桥手术的患者中，广泛的监测用于早期识别可能降低身体器官氧气供应的并发症。然而，心脏直视手术期间通常监测的参数均无法提供有关特定器官氧气供应状态的信息。特别是在体外循环（ECC）期间及之后，可能会发生未被检测到的器官缺氧，并导致术后并发症增加。为了研究在体外循环期间骨骼肌的氧气供应是否发生功能上的显著变化，对14例接受主动脉冠状动脉搭桥手术的患者进行了静息骨骼肌局部pO₂值的pO₂直方图监测。在术中和术后，同时测量全身氧摄取量（VO₂）和骨骼肌的pO₂直方图，以确定在患者降温期间观察到的VO₂下降或复温期间VO₂的增加是否反映在骨骼肌组织pO₂的分布中。患者与方法。研究了14例计划进行2 - 4条主动脉冠状动脉静脉搭桥移植术的患者（年龄42至68岁；男性12例，女性2例）。在麻醉诱导后（1）、开胸后（2）、体外循环期间（3）、体外循环后（2）以及术后每小时直至5小时进行6分钟的测量期。在每个时期测量以下数据：使用pO₂直方图仪测量肱二头肌的pO₂直方图；使用开放式间接量热法测量VO₂；桡动脉和上腔静脉的血气、酸碱平衡和血压；上腔静脉的静脉乳酸；肌肉和直肠温度。结果。在体外循环期间，所有14例患者的平均肌肉pO₂从25 mmHg降至14 mmHg。14例患者中有7例，pO₂值在0至5 mmHg之间的发生率最高（pO₂直方图左移）。体外循环后，平均肌肉pO₂增加到体外循环前观察到的相同值（25 mmHg）。术后前3小时，每位患者的平均肌肉pO₂出现中度下降（范围为23% - 46%）。术后4小时重新达到高于20 mmHg的稳定值。术后个体VO₂的增加与体温升高相关（r = 0.84）；在5例严重寒战的患者中，VO₂明显增加（与最后术中值相比高达130%）。（摘要截断于400字）
