Gabriel A, Werba A, Mares P, Grubhofer G, Hrska F, Griesmacher A, Kretschmer G, Lackner F X, Bircher N G, Schwarz S
Vienna University Medical School, Austria.
J Cardiothorac Vasc Anesth. 1996 Feb;10(2):201-6. doi: 10.1016/s1053-0770(96)80237-0.
To evaluate tissue protection by PGE1 during leg ischemia in patients undergoing aortic surgery.
Randomized, controlled prospective clinical trial.
Single university hospital.
19 consecutive patients undergoing abdominal aortic aneurysm repair.
Patients received infusions of 30 ng/kg/min of PGE1 or saline.
Hemodynamic variables, lactate, creatine phosphokinase, and thromboxane B2 (TXB2) were measured. In the control group, the decrease in cardiac index (CI) after aortic cross-clamping (AXC) persisted until unclamping together with a decrease in femoral venous O2 content (CfvO2). In the PGE1 group, CI returned to baseline with a trend toward greater CfvO2 levels. During reperfusion in the PGE1 group, O2 consumption and lactate levels exceeded preclamp values. Pulmonary hypertension occurred equally in both groups but did not correlate with TXB2, which was not altered by surgery or by PGE1 infusion.
Intraoperative PGE1 treatment offers no benefit and may exacerbate tissue ischemia during AXC by redistributing microcirculatory flow or limiting cellular oxygen utilization in a manner that overwhelms any possible protective effect.
评估前列腺素E1（PGE1）对接受主动脉手术患者腿部缺血期间的组织保护作用。
随机对照前瞻性临床试验。
单一大学医院。
19例连续接受腹主动脉瘤修复术的患者。
患者接受30 ng/kg/min的PGE1或生理盐水输注。
测量血流动力学变量、乳酸、肌酸磷酸激酶和血栓素B2（TXB2）。在对照组中，主动脉交叉阻断（AXC）后心脏指数（CI）的下降持续到松开阻断，同时股静脉血氧含量（CfvO2）下降。在PGE1组中，CI恢复到基线水平，CfvO2水平有升高趋势。在PGE1组再灌注期间，氧消耗和乳酸水平超过阻断前值。两组均出现肺动脉高压，但与TXB2无关，手术或PGE1输注均未改变TXB2水平。
术中PGE1治疗无益处，可能通过重新分配微循环血流或限制细胞氧利用，以超过任何可能保护作用的方式加重AXC期间的组织缺血。
