Gomes W J, Carvalho A C, Palma J H, Teles C A, Branco J N, Silas M G, Buffolo E
Cardiovascular Surgery Discipline, Escola Paulista de Medicina and São Paulo Hospital-Federal University of São Paulo, SP, Brazil.
J Cardiovasc Surg (Torino). 1998 Oct;39(5):619-23.
A new form of postperfusion manifestation is detailed, a vasoplegic syndrome presenting in the postoperative period after cardiopulmonary bypass (CPB) heart surgery.
This retrospective study included sixteen patients who underwent cardiovascular surgery using CPB and exhibited clinical and hemodynamic features compatible with vasoplegic syndrome. The technique of CPB was hypothermic (28 degrees C) in 15 and normothermic in 1 patient, and hypothermic blood cardioplegia was employed in all patients, except 1. The mean CPB time was 121 minutes, ranging from 80 to 210 minutes.
The patients presented a severe feature comprising hypotension, tachycardia, normal or elevated cardiac output, low systemic vascular resistance and decreased filling pressures. Fluid administration alone was not capable of restoring hemodynamic parameters. Physical examination revealed normal capillary filling at the extremities although oliguria and hypotension were observed. These patients needed a high dosage of vasoconstrictor drugs (norepinephrine) for blood pressure control but even high dose norepinephrine did not produce the classical situation of cool extremities and weak peripheral pulses, with increased morbidity and mortality. Severe systemic complications could develop if the vasoplegic syndrome persisted 36-48 hours after its onset. All patients, except 3, presented associated postoperative complications and 4 patients died. The characteristics of vasoplegic syndrome are similar to those observed in septic shock, where the alterations are mediated by cytokines and tumor necrosis factor-alpha.
The appearance of vasoplegic syndrome augmented operative morbidity with a consequent increased risk to the patient in the early postoperative period.
详细描述了一种新的灌注后表现形式，即体外循环（CPB）心脏手术后出现的血管麻痹综合征。
这项回顾性研究纳入了16例接受CPB心血管手术且表现出与血管麻痹综合征相符的临床和血流动力学特征的患者。15例患者采用低温（28摄氏度）CPB技术，1例采用常温CPB技术，除1例患者外，所有患者均采用低温血液停搏液。平均CPB时间为121分钟，范围为80至210分钟。
患者表现出严重的特征，包括低血压、心动过速、心输出量正常或升高、全身血管阻力降低和充盈压下降。仅给予液体不能恢复血流动力学参数。体格检查发现四肢毛细血管充盈正常，尽管观察到少尿和低血压。这些患者需要高剂量的血管收缩药物（去甲肾上腺素）来控制血压，但即使是高剂量的去甲肾上腺素也未产生典型的四肢冰冷和外周脉搏微弱的情况，且发病率和死亡率增加。如果血管麻痹综合征在发病后持续36 - 48小时，可能会出现严重的全身并发症。除3例患者外，所有患者均出现术后相关并发症，4例患者死亡。血管麻痹综合征的特征与脓毒性休克中观察到的特征相似，其中这些改变由细胞因子和肿瘤坏死因子-α介导。
血管麻痹综合征的出现增加了手术发病率，从而在术后早期增加患者风险。
