ABSTRACT
Congenital heart disease(CHD)as the most common type of congenital anatomical deformity,the main treatment is surgical correction undergoing cardiopulmonary bypass.Some children will appear low cardiac output syndrome after the operation,it makes the body blood flow redistribution.The heart and brain are the organs which are ensured the blood perfusion at first.The gastrointestinal tract can not be fully perfused because of that,which makes gastrointestinal tract ischemia and hypoxia,acid metabolites accumulation.Gastric intramucosal pH (pHi)can reflect the gastric mucosal hypoxia status sensitively,warn the low cardiac output syndrome.At present,the pHi determines method includes the salt water tensiometer law and the continual gaseous state tensiometer law. Now,the gastric intramucosal pHi monitoring technology in the application of congenital heart disease was reviewed.
ABSTRACT
BACKGROUND: The blood components of priming solution for cardiopulmonary bypass (CPB) may have opposite roles for tissue perfusion, which are the activation of inflammatory reaction and the improvement of oxygen carrying capacity. This study is aimed to investigate the effect of blood transfusion of priming solution on inflammatory response and tissue perfusion. METHODS: Twenty mongrel dogs randomly allocated and received hypothermic CPB with blood- containing (H group, n=10), or non-hemic (NH group, n=10) priming solution. Gastric intramucosal CO2 concentration (PrCO2), intramucosal pH (pHi), interleukin-8 (IL-8), blood gas and hemodynamic parameters were measured at 1) before CPB, 2) 1 hour during CPB, 3) the end of CPB, 4) 2 hours after CPB, 5) 4 hours after CPB. The ratio of wet to dried lung weight was measured. Statistical verification was performed using repeated measures ANOVA and unpaired t-test. RESULTS: PrCO2 increased and pHi decreased during the study without significant difference between the groups. IL-8 increased in both groups and IL-8 of H group increased higher than that of NH group during the study. The difference between PaCO2 and end-tidal CO2 of NH group was higher than that of H group at 4 hours after CPB. The ratio of wet to dried lung weight was not significantly different between the groups. CONCLUSIONS: We conclude that the allogenic blood in priming solution aggravates the CPB- induced inflammatory reaction, however, the CPB-induced impairment of gastric mucosal perfusion and the pulmonary edema are not significantly affected, compared to non-hemic solution.
Subject(s)
Animals , Dogs , Blood Transfusion , Cardiopulmonary Bypass , Natural Resources , Hemodynamics , Hydrogen-Ion Concentration , Interleukin-8 , Lung Injury , Lung , Oxygen , Perfusion , Pulmonary EdemaABSTRACT
BACKGROUND: Splanchnic perfusion derangement commonly occurs during cardiac surgery, while splanchnic ischemia is known to increase morbidity in surgical and critically ill patients. We hypothesized that anesthetic agents may have different effects on splanchnic perfusion during cardiac surgery. METHODS: Twenty-four patients undergoing cardiac surgery were randomly divided into fentanyl (n = 12) and isoflurane (n = 12) groups. Gastric intramucosal PrCO2 and pHi were measured using tonometry. Patient temperature was maintained at 28 degrees C during cardiopulmonary bypass (CPB). Measurements were made at the following times: (1) baseline, after the induction of anesthesia, (2) 30 minutes into CPB, (3) 60 minutes into CPB, (4) at the end of CPB, (5) one hour after CPB, and (6) 24 hours after CPB. Statistical analysis was performed using repeated measures of ANOVA and the unpaired t-test. RESULTS: The observed hemodynamic changes were similar in both groups. The pHi decreased significantly during hypothermic CPB and remained in this attenuated state up to 24 hours postoperatively in both groups. The pHi in the isoflurane group began to decrease at 30 minutes after starting CPB while that in the fentanyl group decreased at 60 minutes after starting CPB. The pHi of isoflurane group was significantly lower than that of the fentanyl group during CPB and 1 hour after the end of CPB. However, the pHi at 24 hours after CPB was similar in both groups. CONCLUSIONS: We conclude that fentanyl provides more protection from splanchnic ischemic insult than isoflurane during cardiac surgery with hypothermic CPB.