Chiara O, Giomarelli P P, Biagioli B, Rosi R, Gattinoni L
Istituto di Chirurgia D'Urgenza, Universita' di Milano, Italy.
Crit Care Med. 1987 Nov;15(11):995-1000. doi: 10.1097/00003246-198711000-00001.
Sixteen patients undergoing hypothermic cardiopulmonary bypass for open heart surgery were studied prospectively. Oxygen consumption and CO2 production showed a marked increase during the first 6 h postoperatively. Consequently, the measured resting energy expenditure was markedly elevated compared to the predicted energy expenditure. This hypermetabolic response occurred simultaneously with maximum spontaneous rewarming after the end of surgical procedures. Ventricular function was low throughout the postoperative period, and no cardiac response to increased energy requirements was recorded. On the contrary, marked increases in arteriovenous oxygen and CO2 difference were observed during the period of highest resting energy expenditure. We conclude that the first hours after hypothermic cardiopulmonary bypass represent the period of highest risk for decompensation. The continuous monitoring of CO2 production is suggested as a useful clinical method to detect postoperative changes in metabolic rate.
对16例接受心脏直视手术低温体外循环的患者进行了前瞻性研究。术后最初6小时内，氧耗量和二氧化碳生成量显著增加。因此，与预测的能量消耗相比，测得的静息能量消耗明显升高。这种高代谢反应与手术结束后最大程度的自发复温同时发生。术后整个期间心室功能低下，未记录到心脏对能量需求增加的反应。相反，在静息能量消耗最高的时期，动静脉氧和二氧化碳差值显著增加。我们得出结论，低温体外循环后的最初几个小时是失代偿风险最高的时期。建议持续监测二氧化碳生成量，作为检测术后代谢率变化的一种有用的临床方法。
