Haisjackl M, Birnbaum J, Redlin M, Schmutzler M, Waldenberger F, Lochs H, Konertz W, Kox W
Department of Anesthesia and Intensive Care, University Hospital Charité, Humboldt University, Berlin, Germany.
Anesth Analg. 1998 Jan;86(1):22-7. doi: 10.1097/00000539-199801000-00005.
The effect of normothermic (36.2 degrees C +/- 0.6 degree C) nonpulsatile cardiopulmonary bypass (CPB) on splanchnic (hepatic) blood flow (SBF), splanchnic oxygen transport (DO2spl) and oxygen consumption (VO2spl), splanchnic lactate uptake and gastric mucosal pH (pHi, gastric tonometry) was studied in 12 adults (New York Heart Association class II, ejection fraction > or = 0.4) undergoing coronary artery surgery. SBF was estimated with the constant-infusion indocyanine green (ICG) technique using a hepatic venous catheter. DO2spl, VO2spl, and splanchnic lactate uptake were calculated using the Fick principle after the induction of anesthesia, during aortic cross-clamping, after CPB, and 2 and 7 h after admission to the intensive care unit (ICU). SBF, DO2spl, and VO2spl did not decrease during CPB but increased after ICU admission, whereas pHi decreased 7 h after ICU admission. Initial ICG extraction was 0.78, which decreased to 0.54 during aortic clamping and remained low thereafter. The increased arterial blood lactate concentrations were not associated with a decreased splanchnic lactate uptake. We conclude that normothermic CPB is not associated with deterioration in the global intestinal oxygen supply. The increase of blood lactate levels and the decrease in ICG extraction, as well as in pHi, are consistent with a systemic inflammatory response to CPB.
This study demonstrated that normothermic cardiopulmonary bypass (at flows > 2.4 L.min-1.m-2) was not associated with deterioration in global intestinal oxygen delivery, which suggests that increased blood lactate concentrations and decreased gastric mucosal pH and indocyanine green extraction are manifestations of a systemic inflammatory response to cardiopulmonary bypass.
在12例接受冠状动脉手术的成年人（纽约心脏协会II级，射血分数≥0.4）中，研究了常温（36.2℃±0.6℃）非搏动性体外循环（CPB）对内脏（肝脏）血流（SBF）、内脏氧输送（DO2spl）和氧消耗（VO2spl）、内脏乳酸摄取及胃黏膜pH值（pHi，胃张力测定法）的影响。使用肝静脉导管，采用持续输注吲哚菁绿（ICG）技术估算SBF。在麻醉诱导后、主动脉阻断期间、CPB后以及入住重症监护病房（ICU）2小时和7小时后，根据Fick原理计算DO2spl、VO2spl和内脏乳酸摄取量。CPB期间SBF、DO2spl和VO2spl未降低，但入住ICU后升高，而pHi在入住ICU 7小时后降低。初始ICG提取率为0.78，在主动脉阻断期间降至0.54，此后一直保持较低水平。动脉血乳酸浓度升高与内脏乳酸摄取减少无关。我们得出结论，常温CPB与整体肠道氧供应恶化无关。血乳酸水平升高、ICG提取率降低以及pHi降低与对CPB的全身炎症反应一致。
本研究表明，常温体外循环（流量>2.4L·min-1·m-2）与整体肠道氧输送恶化无关，这表明血乳酸浓度升高、胃黏膜pH值降低和吲哚菁绿提取率降低是对体外循环全身炎症反应的表现。
