Vogiatjis Johnny, Noe Khin M, Don Andrea, Cochrane Andrew D, Zhu Michael Z L, Smith Julian A, Ngo Jennifer P, Martin Andrew, Thrift Amanda G, Bellomo Rinaldo, Evans Roger G
Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia.
Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia; Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.
J Cardiothorac Vasc Anesth. 2023 Feb;37(2):237-245. doi: 10.1053/j.jvca.2022.11.008. Epub 2022 Nov 11.
To determine if the administration of norepinephrine to patients recovering from on-pump cardiac surgery is associated with changes in urinary oxygen tension (PO), an indirect index of renal medullary oxygenation.
Single center, prospective observational study.
Surgical intensive care unit (ICU).
A nonconsecutive sample of 93 patients recovering from on-pump cardiac surgery.
In the ICU, norepinephrine was the most commonly used vasopressor agent (90% of patients, 84/93), with fewer patients receiving epinephrine (48%, 45/93) or vasopressin (4%, 4/93). During the 30-to-60-minute period after increasing the infused dose of norepinephrine (n = 89 instances), urinary PO decreased by (least squares mean ± SEM) 1.8 ± 0.5 mmHg from its baseline level of 25.1 ± 1.1 mmHg. Conversely, during the 30-to-60-minute period after the dose of norepinephrine was decreased (n = 134 instances), urinary PO increased by 2.6 ± 0.5 mmHg from its baseline level of 22.7 ± 1.2 mmHg. No significant change in urinary PO was detected when the dose of epinephrine was decreased (n = 21). There were insufficient observations to assess the effects of increasing the dose of epinephrine (n = 11) or of changing the dose of vasopressin (n <4).
In patients recovering from on-pump cardiac surgery, changes in norepinephrine dose are associated with reciprocal changes in urinary PO, potentially reflecting an effect of norepinephrine on renal medullary oxygenation.
确定在接受心脏搭桥手术后恢复中的患者中使用去甲肾上腺素是否与尿氧分压（PO）的变化相关，尿氧分压是肾髓质氧合的一个间接指标。
单中心前瞻性观察性研究。
外科重症监护病房（ICU）。
93例接受心脏搭桥手术后恢复中的患者的非连续样本。
在ICU中，去甲肾上腺素是最常用的血管升压药（90%的患者，84/93），使用肾上腺素的患者较少（48%，45/93），使用血管加压素的患者更少（4%，4/93）。在增加去甲肾上腺素输注剂量后的30至60分钟内（n = 89例），尿PO从其基线水平25.1±1.1 mmHg下降了（最小二乘均值±标准误）1.8±0.5 mmHg。相反，在去甲肾上腺素剂量降低后的30至60分钟内（n = 134例），尿PO从其基线水平22.7±1.2 mmHg升高了2.6±0.5 mmHg。当肾上腺素剂量降低时（n = 21），未检测到尿PO有显著变化。观察数据不足，无法评估增加肾上腺素剂量（n = 11）或改变血管加压素剂量（n<4）的影响。
在接受心脏搭桥手术后恢复中的患者中，去甲肾上腺素剂量的变化与尿PO的相应变化相关，这可能反映了去甲肾上腺素对肾髓质氧合的影响。
