Post cardiac surgery vasoplegia is associated with high preoperative copeptin plasma concentration.
Post cardiac surgery vasoplegia is associated with high preoperative copeptin plasma concentration.
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DOI：
10.1186/cc10516
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Guillon G
中科院分区：
文献类型：
--
作者：
Colson PH;Bernard C;Struck J;Morgenthaler NG;Albat B;Guillon G
心脏手术后血管舒张（PCSV）可能与加压素缺乏有关，加压素缺乏可能与腺垂体的慢性刺激有关。为了评估加压素系统激活，在连续的心脏手术患者中研究了围手术期和肽素和加压素血浆浓度。研究了64例连续的择期心脏手术患者。在体外循环前和体外循环期间以及术后第8小时（H8）记录血流动力学、实验室和临床数据。同时，抽取血液以测定精氨酸加压素（AVP，放射免疫测定法）和和肽素（免疫发光测定法）的血浆浓度。PCSV定义为平均动脉血压< 60 mmHg，心脏指数≥ 2.2 l/min/m2，并使用去甲肾上腺素恢复平均血压> 60 mmHg。将PCSV患者与其他患者（对照组）进行比较。适当时使用Student t检验、Fisher精确检验或非参数检验（Mann-Whitney、Wilcoxon）。AVP和和肽素之间的相关性进行了评估，受试者-操作者特征分析评估术前和肽素的效用，以区分对照组和PCSV患者。PCSV患者体外循环前血浆和肽素浓度显著高于对照组（P < 0.001），H8时AVP浓度显著低于对照组（P < 0.01）。PCSV患者术前存在低钠血症和左心室射血分数降低，并经历了更复杂的手术（重做）。术前和肽素浓度的受试者-操作者特征曲线下面积为0.86 ± 0.04（95%可信区间= 0.78 ~ 0.94; P < 0.001）。术前和肽素血浆浓度的最佳预测值为9.43 pmol/l，敏感性为90%，特异性为77%。高术前和肽素血浆浓度是PSCV的预测指标，并提示术前AVP系统的激活可能有助于内源性AVP储备的耗尽和术后AVP的相对缺乏。
Post cardiac surgery vasodilatation (PCSV) is possibly related to a vasopressin deficiency that could relate to chronic stimulation of adeno-hypophysis. To assess vasopressin system activation, a perioperative course of copeptin and vasopressin plasma concentrations were studied in consecutive patients operated on for cardiac surgery. Sixty-four consecutive patients scheduled for elective cardiac surgery with cardiopulmonary bypass were studied. Hemodynamic, laboratory and clinical data were recorded before and during cardiopulmonary bypass, and at the eighth postoperative hour (H8). At the same time, blood was withdrawn to determine plasma concentrations of arginine vasopressin (AVP, radioimmunoassay) and copeptin (immunoluminometric assay). PCSV was defined as mean arterial blood pressure < 60 mmHg with cardiac index ≥ 2.2 l/min/m2, and was treated with norepinephrine to restore mean blood pressure > 60 mmHg. Patients with PCSV were compared with the other patients (controls). Student's t test, Fisher's exact test, or nonparametric tests (Mann-Whitney, Wilcoxon) were used when appropriate. Correlation between AVP and copeptin was evaluated and receiver-operator characteristic analysis assessed the utility of preoperative copeptin to distinguish between controls and PCSV patients. Patients who experienced PCSV had significantly higher copeptin plasma concentration before cardiopulmonary bypass (P < 0.001) but lower AVP concentrations at H8 (P < 0.01) than controls. PCSV patients had preoperative hyponatremia and decreased left ventricle ejection fraction, and experienced more complex surgery (redo). The area under the receiver-operator characteristic curve of preoperative copeptin concentration was 0.86 ± 0.04 (95% confidence interval = 0.78 to 0.94; P < 0.001). The best predictive value for preoperative copeptin plasma concentration was 9.43 pmol/l with a sensitivity of 90% and a specificity of 77%. High preoperative copeptin plasma concentration is predictive of PSCV and suggests an activation of the AVP system before surgery that may facilitate depletion of endogenous AVP stores and a relative AVP deficit after surgery.
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