Sayın Kart Jülide, Toraman Fevzi
Department of Anesthesiology and Reanimation, University of Health Sciences, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Türkiye.
Department of Anesthesiology and Reanimation, Acıbadem University Faculty of Medicine, Istanbul, Türkiye.
Turk Gogus Kalp Damar Cerrahisi Derg. 2023 Jan 30;31(1):29-36. doi: 10.5606/tgkdc.dergisi.2023.24026. eCollection 2023 Jan.
This study aims to compare the cerebral, hemodynamic, and metabolic effects of different prime solutions used in patients undergoing coronary artery bypass grafting.
Between May 2013 and May 2014, a total of 30 patients (25 males, 5 females; mean age: 59.5±9 years; range, 42 to 78 years) who were schedule for elective isolated coronary artery bypass grafting were included in this prospective study. The patients were randomized into three groups: Group 1 (n=10) (ringer"s lactate [RL]), Group 2 (n=10) (6% hydroxyethyl starch [HES] 130/0.4), and Group 3 (n=10) (RL + 6% HES 130/0.4). Hemodynamic parameters, arterial blood gas analyses, hemoglobin, hematocrit, cerebral regional oxygen saturation, urine output and fluid balance were recorded preoperatively, before and after anesthesia, 10 min after the transition to extracorporeal circulation, while weaning from extracorporeal circulation, and at the end of surgery. Preoperatively and on postoperative Day 5, neuron-specific enolase enzyme and S-100 β protein were assessed. On Day 5 and Week 3 postoperatively, the Standardized Mini-Mental Test was administered to the patients.
The serum neuron-specific enolase enzyme and S-100 β protein levels of the patients were within physiological limits, and there were no clinical findings suggestive of cerebral damage, or changes in the Standardized Mini-Mental Test scores in any of the patients. There was a decrease of more than 20% of the baseline value of cerebral regional oxygen saturation in a total of four patients, one in Group 1 and three in Group 3. No significant difference was observed among the groups in terms of the other parameters.
The prime solution content has no effect on the development of cerebral damage after cardiopulmonary bypass, and the main factor in preventing the development of cerebral damage was the preservation of cerebral perfusion, which can be achieved by monitoring cerebral perfusion in these patients.
本研究旨在比较冠状动脉搭桥手术患者使用不同预充液对脑、血流动力学及代谢的影响。
2013年5月至2014年5月，本前瞻性研究纳入了30例计划行择期单纯冠状动脉搭桥手术的患者（25例男性，5例女性；平均年龄：59.5±9岁；范围42至78岁）。患者被随机分为三组：第1组（n = 10）（乳酸林格液[RL]），第2组（n = 10）（6%羟乙基淀粉[HES] 130/0.4），第3组（n = 10）（RL + 6% HES 130/0.4）。记录术前、麻醉前后、转体外循环10分钟后、体外循环脱机时及手术结束时的血流动力学参数、动脉血气分析、血红蛋白、血细胞比容、脑局部氧饱和度、尿量及液体平衡。术前及术后第5天评估神经元特异性烯醇化酶和S-100β蛋白。术后第5天和第3周对患者进行标准化简易精神状态测试。
患者血清神经元特异性烯醇化酶和S-100β蛋白水平在生理范围内，所有患者均无提示脑损伤的临床表现，标准化简易精神状态测试评分也无变化。共有4例患者脑局部氧饱和度较基线值下降超过20%，其中第1组1例，第3组3例。其他参数在各组间未观察到显著差异。
预充液成分对体外循环后脑损伤的发生无影响，预防脑损伤发生的主要因素是维持脑灌注，通过监测这些患者的脑灌注可实现这一点。
