The effect of nitroglycerin on microvascular perfusion and oxygenation during gastric tube reconstruction
The effect of nitroglycerin on microvascular perfusion and oxygenation during gastric tube reconstruction
复制标题
DOI：
10.1213/01.ane.0000147665.60613.ca
复制
发表时间：
2005-04-01
影响因子：
5.7
通讯作者：
van Bommel, J
中科院分区：
文献类型：
--
作者：
Buise, MP;Ince, C;van Bommel, J
食管切除术后胃管重建是食管癌患者的首选手术治疗方法。颈吻合的并发症与微血管血流受损（MBF）和胃底缺血有关。本研究的目的是区分MBF的减少是由于动脉功能不全还是静脉充血。为此，我们在胃管重建的不同阶段同时评估了MBF、微血管血红蛋白氧饱和度（mu HbSo(2)）和微血管血红蛋白浓度（mu Hbcon）。14例患者用激光多普勒血流法测定MBF，用反射分光光度法测定HbSo(2)和Hbcon。吻合完成后，在眼底涂抹硝酸甘油。虽然幽门的MBF没有显著变化，但手术期间眼底MBF逐渐下降，从基线时（正常胃）的210 +/- 18任意单位下降到重建完成后的52 +/- 9任意单位（平均+/- SEM； P < 0.05）。重建过程中HbSo(2)和Hbcon均无变化。施用硝酸甘油后，MBF增加了一倍。我们得出结论，胃管重建期间MBF减少，但gHbSo(2)和mu Hbcon没有。这种减少可能是静脉充血的结果，这可以通过应用硝酸甘油部分抵消。
Esophagectomy followed by gastric tube reconstruction is the surgical treatment of choice for patients with esophageal cancer. Complications of the cervical anastomosis are associated with impaired microvascular blood flow (MBF) and ischemia in the gastric fundus. The aim of the present study was to differentiate whether the decrease in MBF is a result of arterial insufficiency or of venous congestion. To do this we assessed MBF, microvascular hemoglobin oxygen saturation (mu HbSo(2)), and microvascular hemoglobin concentration (mu Hbcon) simultaneously during different stages of gastric tube reconstruction. In 14 patients, MBF was determined with laser Doppler flowmetry, and mu HbSo(2) and mu Hbcon were determined with reflectance spectro-photometry. After completion of the anastomosis, nitroglycerin was applied at the fundus. Although MBF did not change significantly in the pylorus, MBF decreased progressively during surgery in the fundus from 210 +/- 18 Arbitrary Units at baseline (normal stomach) to 52 +/- 9 Arbitrary Units after completion of reconstruction (mean +/- SEM; P < 0.05). There was no change in mu HbSo(2) and mu Hbcon during the reconstruction. After application of nitroglycerin, MBF doubled. We conclude that MBF decreases during gastric tube reconstruction but that gHbSo(2) and mu Hbcon do not. This decrease might be the result of venous congestion, which can partly be counteracted by application of nitroglycerin.