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Gastrointestinaler Sauerstofftransport und Laktatstoffwechsel während des normothermen kardiopulmonalen Bypasses beim Menschen

The effect of normothermic (36.2°C ± 0.6°C) cardiopulmonary bypass (CPB) on splanchnic blood flow (SBF), splanchnic oxygen transport (DO2 spl) and splanchnic oxygen consumption (VO2 spl), splanchnic lactate uptake and gastric mucosal pH (pHi) was studied in 12 male patients (ejection fraction 0.4) undergoing coronary artery bypass grafting. SBF was estimated by the constant-infusion indocyanine green (ICG) technique using a hepatic venous catheter. DO2spl, VO2spl and splanchnic lactate uptake were calculated using the Fick principle after the induction of anaesthesia, during aortic cross-clamping, after CPB, and 2 and 7 h after admission to the intensive care unit (ICU). SBF, DO2spl and VO2spl did not decrease during CPB but increased after ICU admission, whereas pHi decreased 7 h after ICU admission. Initial ICG extraction was 0.78, which decreased to 0.54 during aortic cross-clamping and remained low thereafter. During normothermic cardiopulmonary bypass there was no deterioration of global splanchnic oxygen supply. The increased arterial blood lactate concentrations were not associated with a decreased splanchnic lactate uptake and are not the result of a decreased gasrointestinal blood flow. Increased blood lactate concentrations and decreased pHi and ICG extraction fraction are consistent with a systemic inflammatory response to CPB.

Identiferoai:union.ndltd.org:HUMBOLT/oai:edoc.hu-berlin.de:18452/15037
Date02 March 1998
CreatorsBirnbaum, Jürgen
ContributorsSparr, H., Koller, J., Kox, W. J.
PublisherHumboldt-Universität zu Berlin, Medizinische Fakultät - Universitätsklinikum Charité
Source SetsHumboldt University of Berlin
LanguageGerman
Detected LanguageEnglish
TypedoctoralThesis, doc-type:doctoralThesis
Formatapplication/pdf, application/octet-stream, application/octet-stream

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