Distinct Alterations in Sublingual Microcirculatory Blood Flow and Hemoglobin Oxygenation in On-Pump and Off-Pump Coronary Artery Bypass Graft Surgery
Distinct Alterations in Sublingual Microcirculatory Blood Flow and Hemoglobin Oxygenation in On-Pump and Off-Pump Coronary Artery Bypass Graft Surgery
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DOI：
10.1053/j.jvca.2010.09.002
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发表时间：
2011-10-01
影响因子：
2.8
通讯作者：
Ince, Can
中科院分区：
文献类型：
--
作者：
Atasever, Bektas;Boer, Christa;Ince, Can
目的：作者假设，与非体外循环冠状动脉搭桥手术相比，体外循环 (CPB)（体外循环）与微循环血流和组织氧合作用更严重的变化相关。设计：一项观察性研究。地点：一所大学医院和教学医院。参与者：接受体外循环 (n = 24) 或非体外循环 (n = 24) 心脏手术的患者。 干预措施：在术前进行微循环测量CPB 和转为 CPB 后 10 分钟或停跳患者心脏脱位之前和期间。测量和主要结果：使用侧流暗场成像研究舌下微循环灌注，并使用反射分光光度法测量舌下微循环氧合。转为 CPB 导致心输出量从 4.0 +/- 0.2 增加到 4.8 +/- 0.3 L/min (p < 0.01)，动脉血红蛋白浓度降低 40%。体外循环与静脉血流速度从 349 +/- 201 μm/s 增加到 563 +/- 227 μm/s (p < 0.05)、功能性毛细血管密度减少 43% 以及剩余填充毛细血管中红细胞的血红蛋白氧合作用从 47.2% +/- 6.1% 增加到 59.7% +/- 相关。 5.2%（p < 0.001）。心脏脱位期间心输出量从 4.5 +/- 1.7 L/min 减少到 1.8 +/- 0.8 L/min (p < 0.01)，而没有血红蛋白变化，这与毛细血管血流完全停止以及最大毛细血管血流速度从 895 +/- 209 降低到 396 +/- 178 μm/s (p < 0.01) 相关。功能性毛细血管密度保持不变，而血红蛋白氧合从 64.2% +/- 9.1% 下降至 48.6% +/- 8.7% (p < 0.01)。结论：体外循环和非体外循环心脏手术与舌下微循环灌注和血红蛋白氧合的明显改变相关。虽然体外循环手术会导致毛细血管脱落，从而导致氧气提取减少，但非体外循环手术会导致脱位期间血流停止，从而导致氧气输送的对流减少。 (C) 2011 Elsevier Inc. 保留所有权利。
Objective: The authors hypothesized that cardiopulmonary bypass (CPB) (on-pump) is associated with more severe changes in the microcirculatory blood flow and tissue oxygenation as compared with off-pump coronary artery bypass surgery.Design: An observational study.Setting: A university hospital and teaching hospital.Participants: Patients undergoing on-pump (n = 24) or off-pump (n = 24) cardiac surgery.Interventions: Microcirculatory measurements were performed before CPB and 10 minutes after the switch to CPB or before and during cardiac luxation in off-pump patients.Measurements and Main Results: Sublingual microcirculatory perfusion was investigated using side-stream dark field imaging, and sublingual microcirculatory oxygenation was measured using reflectance spectrophotometry. Conversion to CPB resulted in an increase in cardiac output from 4.0 +/- 0.2 to 4.8 +/- 0.3 L/min (p < 0.01) and a 40% reduction in arterial hemoglobin concentration. Cardiopulmonary bypass was associated with an increase in venular blood velocity from 349 +/- 201 mu m/s to 563 +/- 227 mu m/s (p < 0.05), a reduction in functional capillary density of 43%, and an increase in hemoglobin oxygenation of the red blood cells in the remaining filled capillaries from 47.2% +/- 6.1% to 59.7% +/- 5.2% (p < 0.001). The decrease in cardiac output during cardiac luxation from 4.5 +/- 1.7 to 1.8 +/- 0.8 L/min (p < 0.01) without hemoglobin changes was associated with a complete halt of capillary blood flow and a reduction in maximum capillary blood velocity from 895 +/- 209 to 396 +/- 178 mu m/s (p < 0.01). The functional capillary density remained unchanged, whereas the hemoglobin oxygenation declined from 64.2% +/- 9.1% to 48.6% +/- 8.7% (p < 0.01).Conclusions: On-pump and off-pump cardiac surgery are associated with distinct alterations in sublingual microcirculatory perfusion and hemoglobin oxygenation. Although on-pump surgery results in a fall out of capillaries resulting in decreased oxygen extraction, off-pump surgery results in a cessation of flow during luxation resulting in decreased convection of oxygen transport. (C) 2011 Elsevier Inc. All rights reserved.