Reves J G, Karp R B, Buttner E E, Tosone S, Smith L R, Samuelson P N, Kreusch G R, Oparil S
Circulation. 1982 Jul;66(1):49-55. doi: 10.1161/01.cir.66.1.49.
Cardiopulmonary bypass (CPB) alters systemic hemodynamics and affects several biochemical systems involved in cardiovascular regulation. We investigated the changes in levels of circulating epinephrine (E) and norepinephrine (NE) and related them to events during CPB. Twenty-eight patients undergoing various surgical procedures were studied. Plasma E and NE were determined by radioenzymatic assay at eight stages of the operation. A ninefold increase in arterial E (from 75 +/- 13 to 708 +/- 117.3 pg/ml) occurred from prebypass (stage 1) measurements to the end of aortic cross-clamping (stage 4). The values at stage 4 were significantly higher (p less than 0.05) than at all other stages. E decreased rapidly, to 360 +/- 84.3 pg/ml, after myocardial and pulmonary reperfusion (stage 5). Arterial NE increased twofold from stage 1 to stage 4 (from 426 +/- 66.9 to 825 +/- 84.2, p less than 0.05). The increase in NE from initial CPB values (stage 2) to 30 minutes of aortic cross-clamping (stage 3) was associated with an increase in mean blood pressure (r = 0.51, p = 0.02). The peak increases in catecholamines occurred when the heart and lungs were excluded from the circulation, which suggests that either or both contributed to the increase. Because the increase in E was markedly greater than that in NE, the predominant humoral response to CPB appears to be adrenomedullary release of E. This significant increase in catecholamines could jeopardize myocardial protective measures during CPB.
体外循环（CPB）会改变全身血流动力学，并影响参与心血管调节的多个生化系统。我们研究了循环肾上腺素（E）和去甲肾上腺素（NE）水平的变化，并将其与体外循环期间的事件相关联。对28例接受各种外科手术的患者进行了研究。在手术的八个阶段通过放射酶法测定血浆E和NE。从体外循环前（第1阶段）测量到主动脉交叉钳夹结束（第4阶段），动脉E增加了九倍（从75±13至708±117.3 pg/ml）。第4阶段的值显著高于所有其他阶段（p<0.05）。心肌和肺再灌注后（第5阶段），E迅速下降至360±84.3 pg/ml。动脉NE从第1阶段到第4阶段增加了两倍（从426±66.9至825±84.2，p<0.05）。NE从体外循环初始值（第2阶段）到主动脉交叉钳夹30分钟（第3阶段）的增加与平均血压的升高相关（r = 0.51，p = 0.02）。儿茶酚胺的峰值增加发生在心脏和肺与循环隔离时，这表明两者中的一个或两个都导致了增加。由于E的增加明显大于NE的增加，体外循环的主要体液反应似乎是肾上腺髓质释放E。儿茶酚胺的这种显著增加可能会危及体外循环期间的心肌保护措施。
