Marques Edouard, Couture Etienne J, Bussières Jean S, Langevin Stephan, Poirier Paul, Voisine Pierre, Caouette Manon, Brassard Patrice
Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.
Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada.
Exp Physiol. 2025 Jun;110(6):798-808. doi: 10.1113/EP092387. Epub 2025 Jan 23.
Cardiopulmonary bypass (CPB) in cardiac surgery is associated with a high risk of postoperative neurological complications. Perioperative use of vasopressors is common to counteract arterial hypotension in this setting. However, use of α-agonist vasopressors has been associated with cerebral desaturations. Given that reductions in cerebral oxygen saturation ( ) can increase postoperative neurological dysfunction, we aimed to investigate the impact of noradrenaline (NA) and phenylephrine (PE) on during the CPB period of a cardiac surgery in 36 patients scheduled for an elective cardiac surgery. Patients were randomized to the intra-operative use of either NA or PE. During CPB, mean arterial pressure (MAP) was elevated pharmacologically to predefined thresholds of 60 and 80 mmHg, while CPB flow was kept constant. The values were recorded for 5 min per MAP threshold. The MAP increased adequately between thresholds of 60 and 80 mmHg (NA, 59 ± 3 vs. 81 ± 3 mmHg and PE, 61 ± 4 vs. 81 ± 3 mmHg; P ˂ 0.01). The decreased between pressure thresholds of 60 and 80 mmHg (NA, 70 ± 11 vs. 69 ± 11 mmHg and PE, 64 ± 11 vs. 63 ± 11 mmHg; P ˂ 0.01). Reduction in did not differ between vasopressors. The mean relative decrease in across groups was 2.0% (95% confidence interval: 0.6 to 2.1). Elevation in MAP mediated solely by vasopressors induces significant decreases in during cardiac surgery under CPB. However, their impact on remains clinically non-significant according to current guidelines.
心脏手术中的体外循环（CPB）与术后神经并发症的高风险相关。在此情况下，围手术期使用血管升压药来对抗动脉低血压很常见。然而，使用α-激动剂血管升压药与脑氧饱和度降低有关。鉴于脑氧饱和度（ ）的降低会增加术后神经功能障碍，我们旨在研究去甲肾上腺素（NA）和去氧肾上腺素（PE）对36例计划进行择期心脏手术患者心脏手术CPB期间 的影响。患者被随机分为术中使用NA或PE。在CPB期间，通过药物将平均动脉压（MAP）升高至预定义的60和80 mmHg阈值，同时CPB流量保持恒定。每个MAP阈值记录 值5分钟。MAP在60至80 mmHg阈值之间充分升高（NA，59±3 vs. 81±3 mmHg和PE，61±4 vs. 81±3 mmHg；P＜0.01）。 在60至80 mmHg压力阈值之间降低（NA，70±11 vs. 69±11 mmHg和PE，64±11 vs. 63±11 mmHg；P＜0.01）。血管升压药之间 的降低没有差异。各组间 的平均相对降低为2.0%（95%置信区间：0.6至2.1）。在CPB下的心脏手术期间，仅由血管升压药介导的MAP升高会导致 显著降低。然而，根据当前指南，它们对 的影响在临床上仍不显著。
