Microcirculatory Alterations in Cardiac Surgery: Effects of Cardiopulmonary Bypass and Anesthesia

被引:140
|
作者
De Backer, Daniel [1 ]
Dubois, Marc-Jacques
Schmartz, Denis
Koch, Marc
Ducart, Anne
Barvais, Luc
Vincent, Jean-Louis
机构
[1] Free Univ Brussels, Dept Intens Care, Erasme Hosp, B-1070 Brussels, Belgium
来源
ANNALS OF THORACIC SURGERY | 2009年 / 88卷 / 05期
关键词
FAILURE ASSESSMENT SCORE; BLOOD-FLOW; OXYGEN DELIVERY; ORGAN FAILURE; SEPTIC SHOCK; EXTRACORPOREAL-CIRCULATION; MUSCLE MICROCIRCULATION; INFLAMMATORY RESPONSE; SEPSIS; ENDOTOXEMIA;
D O I
10.1016/j.athoracsur.2009.07.002
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Heterogeneity in microvascular perfusion is associated with impaired tissue oxygenation. We hypothesized that cardiac surgery with or without cardiopulmonary bypass (CPB) could induce microvascular alterations. Methods. We used an orthogonal polarization spectral imaging technique to evaluate the sublingual microcirculation in patients undergoing cardiac surgery with (n = 9) or without (n = 6) CPB. We also included, as a control group, 7 patients undergoing thyroidectomy with the same anesthetic procedure. Hemodynamic and microcirculatory variables were obtained the day before surgery, after induction of anesthesia, during CPB, on admission to the intensive care unit or the recovery room, and 6 and 24 hours after the end of the surgical procedure. Data are presented as median (25th to 75th percentile). Results. No differences in hemodynamic variables were observed between the two cardiac surgery groups. The proportion of perfused vessels was similar in all three groups at baseline (89% [87% to 90%]), and decreased similarly after induction of anesthesia to 71% (69% to 74%). It decreased further during CPB to 53% (50% to 56%). On admission to the intensive care unit or recovery room, alterations were more severe in CPB than in off-pump patients (60% [59% to 62%] versus 64% [61% to 65%]; p = 0.03), whereas they had already normalized in thyroidectomy patients (89% [86% to 90%]; p = 0.0005 versus cardiac surgery). In both cardiac surgery groups these microcirculatory alterations decreased with time, but persisted at 24 hours. The severity of microvascular alterations correlated with peak lactate levels after cardiac surgery (y = 11.5 - 0.15x; r(2) = 0.65; p < 0.05). Conclusions. Microcirculatory alterations are observed in cardiac surgery patients whether or not CPB is used. Anesthesia contributes to these alterations, but its effects are transient. (Ann Thorac Surg 2009;88:1396-403) (C) 2009 by The Society of Thoracic Surgeons
引用
收藏
页码:1396 / 1403
页数:8
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