Repozitorij Medicinskog fakulteta Sveučilišta u Zagrebu

Off-pump coronary bypass surgery adversely affects alveolar gas exchange

Gašparović, Hrvoje and Unić, Daniel and Sutlić, Željko and Husedžinović, Ino and Biočina, Bojan and Rudež, Igor and Nikić, Nada and Jelić, Ivan (2008) Off-pump coronary bypass surgery adversely affects alveolar gas exchange. Collegium antropologicum, 32 (1). pp. 293-298. ISSN 0350-6134 (Print)

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    Croatian abstract

    Hipoteza da će uvođenje kirurške revaskularizacije miokarda bez upotrebe izvantjelesnog krvotoka (OPCAB, od engl. Off pump coronary artery bypass) dramatično smanjiti incidenciju respiratornih komplikacija u odnosu na klasični zahvat nije našla svoju potvrdu u praksi. U ovoj studiji evaluirali smo utjecaj kirurške traume koja prati OPCAB na alveolo-kapilarnu membranu te kvantificirali količinu laktata koju pluća otpuštaju u cirkulaciju kao odgovor na istu. Nadalje, analizirana je korelacija između laktata otpuštenog iz pluća te ukupnog sistemskog laktata. Studija je dizajnirana kao prospektivno opservacijsko istraživanje. Analizirano je 40 konzekutivnih bolesnika kod kojih je učinjena revaskularizacija miokarda bez upotrebe izvantjelesnog krvotoka. Prosječna dob ispitanika bila je 60±10 godina. Prosječni EUROScore bio je 3,8±2,9. Alveolo-arterijski gradijent parcijalnog tlaka kisika (A-a gradijent O2) porastao je sa 19 [raspon 9 do 30] na 26 [raspon 20 do 34] kPa (P<0,001). Povišene vrijednosti A-a gradijenta O2 bile su registrirane do 6 sati iza zahvata, nakon čega je postojao nagli trend normalizacije vrijednosti. Iako je zabilježen porast u otpuštanju laktata iz pluća kao odgovor na kiruršku traumu sa 0,022 [raspon –0,074 do 0,066] na 0,089 [raspon 0,016 do 0,209] mmol/min/m2, isti nije dosegao statističku značajnost (P=0,105). Sistemska koncentracija laktata je porasla sa 0,94 [raspon 0,78 do 1,06] na 1,39 [raspon 0,97 do 2,81] mmol/L (P<0,001). Venoarterijska razlika u parcijalnom tlaku ugljičnog dioksida nije ukazala na značajniju varijabilnost u promatranom razdoblju. Mortalitet u ovoj kohorti bolesnika bio je 2,5% (1/40). Pokazali smo korelaciju između otpuštanja laktata iz pluća i ukupne sistemske koncentracije laktata (R=0,46; P=0,003). Plućna ozljeda nakon OPCAB kirurgije u našoj je studiji demonstrirana naglim porastom alveolo-arterijskog gradijenta parcijalnog tlaka kisika. Klinička implikacija navedenog porasta A-a gradijenta O2 bila je u njegovoj korelaciji sa dužinom trajanja mehaničke ventilacije.

    English abstract

    While the introduction of off-pump myocardial revascularization (OPCAB) has initially shown promise in reducing respiratory complications inherent to conventional coronary surgery, it has failed to eradicate them. Our study focused on quantifying the lactate release from the lungs and the dysfunction at the level of the alveolar-capillary membrane precipitated by OPCAB at different time points after the insult. Furthermore, we aimed to determine the impact of pulmonary lactate production on systemic lactic acid concentrations. The study was conducted in a prospective observational fashion. Forty consecutive patients undergoing OPCAB were analyzed. The mean patient age was 60 +/- 10 years. The mean EUROScore was 3.8 +/- 2.9. The alveolar-arterial O2 gradient increased from 19 [range 9 to 30] to 26 [range 20 to 34] kPa (P < 0.001) and remained elevated up to 6 hours after surgery. It rapidly declined again by 18 hours postoperatively. The observed increase in the pulmonary lactate release (PLR) from a baseline value of 0.022 [range -0.074 to 0.066] to 0.089 [range 0.016 to 0.209] mmol/min/m2 at six hours postoperatively did not reach statistical significance (P = 0.105). The systemic arterial lactate (Ls) concentration increased from 0.94 [range 0.78 to 1.06] to 1.39 [range 0.97 to 2.81] mmol/L (P < 0.001). The venoarterial pCO2 difference showed no significant change in comparison to baseline values. The mortality in the studied group was 2.5% (1/40). The pulmonary lactate production showed a statistically significant correlation with the systemic lactate concentration (R = 0.46; P = 0.003). Pulmonary injury following off pump myocardial revascularization was evidenced by a prompt increase in the alveolar-arterial oxygen gradient. The alveolar-arterial O2 gradient correlated with the duration of mechanical ventilation.

    Item Type: Article
    MeSH: Coronary Artery Bypass, Off-Pump - adverse effects ; Pulmonary Gas Exchange ; Female ; Humans ; Lactic Acid - biosynthesis ; Lung - metabolism ; Male ; Middle Aged
    Divisions: Katedra za kirurgiju
    Depositing User: Boris Čičovački
    Status: Published
    Creators:
    CreatorsEmail
    Gašparović, Hrvoje
    Unić, Daniel
    Sutlić, Željko
    Husedžinović, Ino
    Biočina, Bojan
    Rudež, Igor
    Nikić, Nada
    Jelić, Ivan
    Date: March 2008
    Date Deposited: 02 Oct 2008
    Last Modified: 23 Sep 2011 18:10
    Subjects: /
    Related URLs:
      URI: http://medlib.mef.hr/id/eprint/378

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