Speziale G, Ruvolo G, Marino B
Institute of Cardiac Surgery, University of Rome "La Sapienza", Italy.
J Cardiovasc Surg (Torino). 1996 Jun;37(3):301-3.
Cardiopulmonary bypass (CPB) is frequently associated with hemodynamic disorders caused by a whole blood inflammatory response. In particular vasoplegic syndrome occurs in the immediate postoperative time of patients who underwent normothermic CPB. Nitric oxide (NO) was described as an endothelium derived relaxing factor (EDRF). We report changes in NO concentration occurred in patients who experienced vasoplegic syndrome following CPB.
We analyzed changes in NO concentration in 95 consecutive patients who underwent coronary artery bypass grafting under normothermic CPB. NO was measured as nitrite plasma level (NPL) by the Griess reaction.
In all cases a significant NPL increase 30 minutes after starting CPB and 10 minutes after CPB interruption was observed (p<0.005). No significant differences were measured 60, 120 and 240 min after CPB interruption when compared with before CPB. Three patients experienced vasoplegic syndrome and NPL values measured at 60, 120 and 240 min after CPB interruption were still significantly increased when compared with before CPB (p<0.005).
NO plays a role in the CPB-related hemodynamic disorders. Use of NO synthase inhibitors could provide a better management of vasoplegic phenomenon following CPB.
体外循环（CPB）常与全血炎症反应引起的血流动力学紊乱相关。特别是在接受常温CPB的患者术后即刻会发生血管麻痹综合征。一氧化氮（NO）被描述为一种内皮源性舒张因子（EDRF）。我们报告了CPB后发生血管麻痹综合征的患者中NO浓度的变化。
我们分析了95例在常温CPB下行冠状动脉旁路移植术的连续患者的NO浓度变化。通过格里斯反应将NO作为血浆亚硝酸盐水平（NPL）进行测量。
在所有病例中，观察到CPB开始后30分钟和CPB中断后10分钟时NPL显著升高（p<0.005）。与CPB前相比，CPB中断后60、120和240分钟时未测得显著差异。3例患者发生血管麻痹综合征，与CPB前相比，CPB中断后60、120和240分钟时测得的NPL值仍显著升高（p<0.005）。
NO在CPB相关的血流动力学紊乱中起作用。使用一氧化氮合酶抑制剂可以更好地管理CPB后的血管麻痹现象。
