Oudemans-van Straaten H M, Jansen P G, te Velthuis H, Beenakkers I C, Stoutenbeek C P, van Deventer S J, Sturk A, Eysman L, Wildevuur C R
Intensive Care Department, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
Intensive Care Med. 1996 Apr;22(4):294-300. doi: 10.1007/BF01700449.
The aim of this study was to determine whether the increase in post-operative oxygen consumption (delta VO2) in cardiac surgery patients is related to endotoxemia and subsequent cytokine release and whether delta VO2 can be used as a parameter of post-perfusion syndrome.
Prospective study.
Operating room and intensive care unit of a university hospital.
Twenty-one consecutive male patients undergoing elective coronary artery bypass surgery without major organ dysfunction and not receiving corticosteroids.
Plasma levels of endotoxin, tumor necrosis factor (TNF) and interleukin-6 (IL-6) were measured before, during and for 18 h after cardiac surgery. Oxygen consumption, haemodynamics, the use of IV fluids and dopamine, body temperature and the time of extubation were also measured. Measurements from patients with high delta VO2 (> or = median value of the entire group) were compared with measurements from patients with low delta VO2 (< median). Patients with high delta VO2 had higher levels of circulating endotoxin (P = 0.004), TNF (P = 0.04) and IL-6 (P = 0.009) received more IV fluids and dopamine while in the ICU, and were extubated later than patients with low delta VO2. Several hours after delta VO2 the patient's body temperature rose. Forward stepwise regression analysis showed that circulating endotoxin and TNF explained 50% of the variability of delta VO2.
This study demonstrates that patients with high post operative oxygen consumption after elective cardiac surgery have higher circulating levels of endotoxin, TNF and IL-6 and also have more symptoms of post-perfusion syndrome. Early detection of high VO2 might be used as a clinical signal to improve circulation in order to meet the high oxygen demand of inflammation. In addition, continuous measurement of VO2 provides us with a clinical parameter of inflammation in interventional studies aiming at a reduction of endotoxemia or circulating cytokines.
本研究旨在确定心脏手术患者术后氧耗量增加（ΔVO₂）是否与内毒素血症及随后的细胞因子释放有关，以及ΔVO₂是否可作为灌注后综合征的一个参数。
前瞻性研究。
一所大学医院的手术室和重症监护病房。
21例连续接受择期冠状动脉搭桥手术的男性患者，无主要器官功能障碍且未接受皮质类固醇治疗。
在心脏手术前、手术期间及术后18小时测量血浆内毒素、肿瘤坏死因子（TNF）和白细胞介素-6（IL-6）水平。还测量了氧耗量、血流动力学、静脉输液和多巴胺的使用情况、体温及拔管时间。将ΔVO₂高（≥全组中位数）的患者的测量值与ΔVO₂低（<中位数）的患者的测量值进行比较。ΔVO₂高的患者循环内毒素（P = 0.004）、TNF（P = 0.04）和IL-6（P = 0.009）水平较高，在重症监护病房期间接受更多的静脉输液和多巴胺治疗，且拔管时间比ΔVO₂低的患者晚。ΔVO₂数小时后患者体温升高。向前逐步回归分析表明，循环内毒素和TNF可解释ΔVO₂变异性的50%。
本研究表明，择期心脏手术后氧耗量高的患者循环内毒素、TNF和IL-6水平较高，且灌注后综合征症状更多。早期检测到高VO₂可能作为一种临床信号，用于改善循环以满足炎症的高氧需求。此外，在旨在减少内毒素血症或循环细胞因子的干预研究中，连续测量VO₂为我们提供了一个炎症的临床参数。
