Effect of hypothermia on rectal mucosal perfusion in infants undergoing cardiopulmonary bypass
Effect of hypothermia on rectal mucosal perfusion in infants undergoing cardiopulmonary bypass
复制标题
DOI：
10.1093/bja/77.5.591
复制
发表时间：
1996-11-01
影响因子：
9.8
通讯作者：
Franks, R
中科院分区：
文献类型：
--
作者：
Booker, PD;Prosser, DP;Franks, R
我们研究了低温对 1.4-45 周、肺旁路 (CPB) 婴儿肠道粘膜的影响。麻醉诱导后，将激光多普勒探头插入患者直肠 8 厘米，以便在整个手术过程中监测直肠粘膜灌注（“通量”）。 35℃ CPB 10 分钟后、CPB 诱导冷却至 15-25℃ 后、复温前立即和复温至 35℃ 后达到稳态观察期（5 分钟，温度或平均动脉压 (MAP) 无变化）。在这些期间，流速为 100 ml kg(-1) min(-1)，细胞堆积体积保持恒定，步速保持在 5.3 +/- 0.5kPa。未使用血管活性药物。初始温暖和复温 MAP 值 (46 mm Hg) 显着低于冷 CPB 期间（63 和 64 mm Hg）（P = 0.008）。第一个寒冷期的平均通量 (152) 显着低于第一个温暖的 CPB 期 (211) (P = 0.001)。复温后通量 (127) 显着低于所有其他 CPB 通量值 (P = 0.004)。我们的结论是，虽然低温显着减少了粘膜血流量，但复温会导致粘膜灌注更大程度的减少，这可能对粘膜缺氧的发生至关重要。
We have examined the effect hypothermia on gut mucosal infants, aged 1.4-45 weeks, pulmonary bypass (CPB). After induction of anaesthesia, a laser Doppler probe was inserted 8 cm into the patient's rectum to allow monitoring of rectal mucosal perfusion (''flux'') throughout operation. Steady-state observation periods (5 min with no change in temperature or mean arterial pressure (MAP)) were achieved after 10 min on CPB at 35 degrees C, after CPB-induced cooling to 15-25 degrees C, immediately before rewarming and after rewarming to 35 degrees C. Throughout these periods flow rate was 100 ml kg(-1) min(-1), packed cell volume was kept constant and Pace, maintained at 5.3 +/- 0.5 kPa. No vasoactive drugs were used. Initial warm and rewarm MAP values (46 mm Hg) were significantly lower (P = 0.008) than during the cold CPB periods (63 and 64 mm Hg). Mean flux in the first cold period (152) was significantly lower (P = 0.001) than that in the first warm CPB period (211). Post-rewarm flux (127) was significantly lower than all other CPB flux values (P = 0.004). We con elude that although hypothermia significantly reduced mucosal blood flow, rewarming produced even greater reductions in mucosal perfusion that may prove crucial in the development of mucosal hypoxia.