Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Yangsan, Korea.
Department of Anesthesia and Pain Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea.
Korean J Anesthesiol. 2022 Aug;75(4):338-349. doi: 10.4097/kja.22097. Epub 2022 May 27.
Microcirculatory disturbances are typically most severe during cardiopulmonary bypass (CPB), which occurs during cardiac surgeries. If microvascular reactivity compensates for microcirculatory disturbances during CPB, tissue hypoxemia can be minimized. The primary aim of this study was to assess whether microvascular reactivity during CPB could predict major adverse events (MAE) after cardiac surgery.
This prospective observational study included 115 patients who underwent elective on-pump cardiac surgeries. A vascular occlusion test (VOT) with near-infrared spectroscopy was performed five times for each patient: before the induction of general anesthesia, 30 min after the induction of general anesthesia, 30 min after applying CPB, 10 min after protamine injection, and post-sternal closure. The postoperative MAE was recorded. The area under the receiver operating characteristic (AUROC) curve analysis was performed for the prediction of MAE using the recovery slope.
Of the 109 patients, MAE occurred in 32 (29.4%). The AUROC curve for the recovery slope during CPB was 0.701 (P < 0.001; 95% CI [0.606, 0.785]). If the recovery slope during CPB was < 1.08%/s, MAE were predicted with a sensitivity of 62.5% and specificity of 72.7%.
Our study demonstrated that the recovery slope of the VOT during CPB could predict MAE after cardiac surgery. These results support the idea that disturbances in microcirculation induced by CPB can predict the development of poor clinical outcomes, thereby demonstrating the potential role of microvascular reactivity as an early predictor of MAE after cardiac surgery.
心肺旁路（CPB）期间通常会出现最严重的微循环障碍，这种情况发生在心脏手术期间。如果 CPB 期间微血管反应性能够代偿微循环障碍，则可以最大限度地减少组织缺氧。本研究的主要目的是评估 CPB 期间的微血管反应性是否可以预测心脏手术后的主要不良事件（MAE）。
本前瞻性观察研究纳入了 115 例行体外循环心脏手术的择期患者。对每位患者进行 5 次血管闭塞试验（VOT）与近红外光谱检查：全麻诱导前、全麻诱导后 30 分钟、CPB 后 30 分钟、鱼精蛋白注射后 10 分钟和胸骨关闭后。记录术后 MAE。使用恢复斜率对 MAE 进行预测，对其进行接收器工作特征（AUROC）曲线分析。
在 109 例患者中，32 例（29.4%）发生 MAE。CPB 期间恢复斜率的 AUROC 曲线为 0.701（P < 0.001；95%CI[0.606，0.785]）。如果 CPB 期间的恢复斜率<1.08%/s，则可以预测 MAE，其敏感性为 62.5%，特异性为 72.7%。
本研究表明，CPB 期间 VOT 的恢复斜率可以预测心脏手术后的 MAE。这些结果支持 CPB 引起的微循环障碍可以预测不良临床结局发展的观点，从而表明微血管反应性作为心脏手术后 MAE 的早期预测指标的潜在作用。
