Thangathurai D, Charbonnet C, Wo C C, Shoemaker W C, Mikhail M S, Roffey P, Roessler P, Kuchta K, Zelman V, DeMeester T R, Katz R
Department of Anesthesiology, University of Southern California School of Medicine, Los Angeles, USA.
New Horiz. 1996 Nov;4(4):466-74.
Patients undergoing prolonged, complex oncological surgery are at increased risk of developing the adult respiratory distress syndrome (ARDS) and other organ failures. Our hypothesis is that maintaining adequate tissue perfusion and oxygenation may prevent tissue hypoxia and acidosis in pulmonary, peripheral, and splanchnic microcirculations. Experimental evidence suggests that the hypoxic, acidotic endothelium stimulates the release of cytokines, kinins, and other mediators. We developed and tested an intraoperative protocol for surgical patients likely to develop ARDS and organ dysfunction; the protocol focuses on the intraoperative period but is not limited to this time. Nitroglycerin and fluids were used to maintain tissue perfusion and prevent tissue hypoxia as reflected by transcutaneous oxygen tension values. In 155 high-risk patients, none developed ARDS. We conclude that maintenance of tissue perfusion and oxygenation in high-risk surgical patients decreases the incidence of ARDS.
接受长时间复杂肿瘤手术的患者发生成人呼吸窘迫综合征（ARDS）和其他器官功能衰竭的风险增加。我们的假设是，维持充足的组织灌注和氧合可预防肺、外周和内脏微循环中的组织缺氧和酸中毒。实验证据表明，缺氧、酸中毒的内皮会刺激细胞因子、激肽和其他介质的释放。我们制定并测试了一种针对可能发生ARDS和器官功能障碍的手术患者的术中方案；该方案侧重于术中阶段，但不限于这个时间段。使用硝酸甘油和液体来维持组织灌注，并通过经皮氧分压值来预防组织缺氧。在155例高危患者中，无人发生ARDS。我们得出结论，高危手术患者维持组织灌注和氧合可降低ARDS的发生率。
