Department of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, Germany.
Department of Cardiovascular Surgery, Clinical Perfusion, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, Germany.
Medicina (Kaunas). 2024 Sep 24;60(10):1564. doi: 10.3390/medicina60101564.
: The majority of cardiac surgical procedures are performed using cardiopulmonary bypass and cardioplegia-induced cardiac arrest. Cardiac arrest and reperfusion may lead to ischemia-reperfusion injury of the myocardium. The aim of this study was to investigate whether gradual reperfusion with a slow increase in oxygen partial pressure leads to a reduction in reperfusion injury. : Fifty patients undergoing elective cardiac surgery were included in this prospective randomized study. Patients in the hyperoxemic (control) group received conventional reoxygenation (paO 250-300 mmHg). Patients in the normoxemic (study) group received gradual reoxygenation (1st-minute venous blood with paO 30-40 mmHg, 2nd-minute arterial blood with paO 100-150 mmHg). Periprocedural blood samples were taken serially, and markers of myocardial injury were analyzed. In addition, the influence of gradual reoxygenation on hemodynamics, inflammation, and the overall perioperative course was evaluated. : There was a trend toward higher CK levels in the hyperoxemia group without statistical significance; however, CK-MB and troponin T levels did not show any statistical difference between the two groups. Potassium concentrations in the coronary sinus were significantly higher in the hyperoxemia group at 3 and 8 min after opening of the aortic cross-clamp (6.88 ± 0.87 mmol/L vs. 6.30 ± 0.91 mmol/L and 5.87 ± 0.73 mmol/L vs. 5.43 ± 0.42 mmol/L, respectively; = 0.03 and = 0.02). All other measurements did not show a statistical difference between the two groups. : The use of gradual reperfusion in cardiac surgery with cardiopulmonary bypass and cardiac arrest is safe. However, it does not reduce ischemia-reperfusion injury compared to standard hyperoxemic reperfusion.
：大多数心脏外科手术都是在心肺旁路和心脏停搏诱导下进行的。心脏停搏和再灌注可能导致心肌缺血再灌注损伤。本研究旨在探讨逐渐增加氧分压的再灌注是否会减少再灌注损伤。
：50 例行择期心脏手术的患者纳入本前瞻性随机研究。高氧组（对照组）患者接受常规复氧（PaO2 50-300mmHg）。正常氧组（研究组）患者接受逐渐复氧（第 1 分钟静脉血 PaO2 30-40mmHg，第 2 分钟动脉血 PaO2 100-150mmHg）。术中连续采集血样，分析心肌损伤标志物。此外，还评估了逐渐复氧对血流动力学、炎症和整个围手术期过程的影响。
：高氧组 CK 水平升高趋势，但无统计学意义；然而，CK-MB 和肌钙蛋白 T 水平在两组间无统计学差异。主动脉阻断开放后 3 和 8 分钟，冠状窦钾浓度在高氧组明显升高（分别为 6.88±0.87mmol/L 比 6.30±0.91mmol/L 和 5.87±0.73mmol/L 比 5.43±0.42mmol/L；=0.03 和=0.02）。两组间其他测量值均无统计学差异。
：在心肺旁路和心脏停搏心脏手术中使用逐渐复氧是安全的。然而，与标准高氧复氧相比，它并不能减少缺血再灌注损伤。
