Lajos T Z, Venditti J, Venuto R
J Thorac Cardiovasc Surg. 1985 Jun;89(6):934-41.
Nine patients (seven men and two women) were studied while undergoing coronary artery bypass on cardiopulmonary bypass. Selective bronchial flow samples were obtained and analyzed for prostaglandin E2 levels, and the hemodynamic effects of this vasodilator were studied. Bronchial flow collection and measurements were performed during hypothermic cardioplegic arrest while the peripheral anastomosis was being completed, as described previously. This collected sample was reinfused abruptly to the pump circuit, but samples were also analyzed for specific radioimmunoassay antiserum for prostaglandin E2 levels. Urine levels were obtained both with and without indomethacin block. All nine patients were studied for the hemodynamic effects of rapidly reinfused bronchial flow. A 34% +/- 8.8% mean drop of blood pressure and peripheral vascular resistance were recorded (p less than 0.002). Three study groups were established: In Group I, serum prostaglandin assay was performed on six patients. Prostaglandin E2 levels showed an average of increase of 159% compared to the baseline (p less than 0.02). In Group II, urine prostaglandin was measured. Nine assays were performed on six patients. Analysis of the total urine production while on cardiopulmonary bypass showed an average increase in prostaglandin E2 of 300% (p less than 0.02). In Group III, combined serum and urine prostaglandin levels were measured in three patients before and after indomethacin block (50 mg four times a day for 48 hours before the operation). All of these patients demonstrated the same hypotensive phenomena with reinfusion of the bronchial flow. The urinary prostaglandin E2 output and serum prostaglandin E2 levels in bronchial flow were elevated. Overall, this group manifested a 50% reduction in prostaglandin E2 production over baseline values with indomethacin block (p less than 0.02) and a 300% increase in production during cardiopulmonary bypass (p less than 0.02). Our data suggest that significant amounts of prostaglandin E2 are released in the lung during the stress of cardiac operations. Rapid reinfusion of bronchial flow is responsible for hypotension during cardiopulmonary bypass. Pretreatment with indomethacin will not completely block prostaglandin E2 release in the lung during stress.
九名患者（七名男性和两名女性）在接受体外循环冠状动脉搭桥手术时接受了研究。获取选择性支气管血流样本并分析前列腺素E2水平，并研究这种血管扩张剂的血流动力学效应。如前所述，在低温心脏停搏期间完成外周吻合时进行支气管血流采集和测量。采集的样本突然回输到泵回路中，但样本也用于分析前列腺素E2水平的特异性放射免疫测定抗血清。在使用和不使用吲哚美辛阻断的情况下获取尿液水平。对所有九名患者进行了快速回输支气管血流的血流动力学效应研究。记录到平均血压和外周血管阻力下降34%±8.8%（p<0.002）。设立了三个研究组：在第一组中，对六名患者进行了血清前列腺素测定。前列腺素E2水平与基线相比平均升高了159%（p<0.02）。在第二组中，测量了尿液前列腺素。对六名患者进行了九次测定。对体外循环期间的总尿量分析显示，前列腺素E2平均增加了300%（p<0.02）。在第三组中，在吲哚美辛阻断（术前48小时每天四次，每次50毫克）前后对三名患者测量了血清和尿液前列腺素的联合水平。所有这些患者在回输支气管血流时都表现出相同的低血压现象。支气管血流中的尿液前列腺素E2输出量和血清前列腺素E2水平升高。总体而言，该组在吲哚美辛阻断后前列腺素E2生成量比基线值降低了50%（p<0.02），在体外循环期间生成量增加了300%（p<0.02）。我们的数据表明，在心脏手术应激期间，肺中会释放大量前列腺素E2。支气管血流的快速回输是体外循环期间低血压的原因。术前用吲哚美辛治疗不能完全阻断应激期间肺中前列腺素E2的释放。
