Kiyama H, Ohshima N, Hata I, Satoh Y, Murai N, Katayama Y, Irie Y, Imazeki T, Yamada T
Department of Cardiovascular and Thoracic Surgery, Koshigaya Hospital, Dokkyo University School of Medicine, Saitama, Japan.
Kyobu Geka. 1997 Nov;50(12):1013-7.
Normothermic cardiopulmonary bypass (CPB) is being increasingly used at some institutions. Patients undergoing normothermic CPB have a higher systemic oxygen demand and may be at higher risk for ischemic injury. This study was designed to confirm the clinical efficacy and safety of tepid hypothermic CPB. Thirty-six patients undergoing open heart surgery between June 1993 and August 1994 were divided into two groups: tepid (n = 18, 32 degrees C) and moderate (n = 18, 26 degrees C) hypothermic CPB. There were no significant differences in preoperative and perioperative patients characteristics between the two groups. The mean aortic cross-clamp time did not differ between two groups, but the mean CPB time was significantly shorter in tepid hypothermic patients. Serum lactate after CPB and lactate/pyrvate ratio during CPB in tepid hypothermic patients were significantly lower than in moderate hypothermic patients. The mixed venous oxygen saturation in tepid hypothermic patients was significantly lower however, it was maintained at levels more than 70% during CPB. This study suggests that tepid hypothermic CPB is a safe and effective alternative to moderate hypothermic CPB for patients undergoing open heart surgery. Previous reports have documented that patients undergoing normothermic CPB are at greater risk for cerebral desaturation. We should evaluate cerebral venous oxygen saturation during tepid hypothermic CPB before the induction of normothermic CPB.
常温体外循环（CPB）在一些机构中越来越多地被使用。接受常温CPB的患者全身氧需求更高，可能面临更高的缺血性损伤风险。本研究旨在证实微低温CPB的临床疗效和安全性。1993年6月至1994年8月期间接受心脏直视手术的36例患者被分为两组：微低温组（n = 18，32摄氏度）和中度低温组（n = 18，26摄氏度）。两组患者术前和围手术期特征无显著差异。两组的平均主动脉阻断时间无差异，但微低温患者的平均CPB时间明显更短。微低温患者CPB后的血清乳酸水平和CPB期间的乳酸/丙酮酸比值显著低于中度低温患者。然而，微低温患者的混合静脉血氧饱和度显著较低，但其在CPB期间维持在70%以上的水平。本研究表明，对于接受心脏直视手术的患者，微低温CPB是中度低温CPB的一种安全有效的替代方法。先前的报告记录了接受常温CPB的患者发生脑氧饱和度降低的风险更高。在诱导常温CPB之前，我们应该评估微低温CPB期间的脑静脉血氧饱和度。
