Metabolic acidosis after cardiac surgery with cardiopulmonary bypass revisited with the use of the Stewart acid-base approach

被引:0
作者
Gueret, G.
Rossignol, B.
Kiss, G.
Wargnier, J. -P.
Corre, O.
Bezon, E.
Carre, J. -L.
Arvieux, C. -C.
机构
[1] CHU Cavale Blanche, Dept Anesthesie Reanimat, F-29609 Brest, France
[2] CHU Cavale Blanche, Serv Chirurg Cardiaque Thorac & Vasc, F-29609 Brest, France
[3] CHU Cavale Blanche, Serv Biochim, F-29609 Brest, France
来源
ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION | 2007年 / 26卷 / 01期
关键词
metabolic acidosis; cardiac surgery;
D O I
10.1016/j.annfar.2006.07.083
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Introduction. - According to the Stewart approach of acid-base regulation, chloride from either volume replacement or cardiopulmonary bypass (CPB) priming solution may induce metabolic acidosis. The alternative hypothesis stands in volume dilution with solutions free of bicarbonate. Objectives. - Evaluate the acid-base status of patients undergoing cardiac surgery with CPB priming containing chloride and bicarbonate. Material and methods. - Prospective study. Methods. - Twenty-eight patients were prospectively included. Priming of CPB contained 47.4 mmol/l of bicarbonate and 97.7 mmol/l of chloride. Arterial blood samples were taken at 3 timings: prior (T1) and after (T2) CPB, and on arrival in the ICU (T3). Following measurements were performed: Na+, K+, Cl-, Mg++, Ca++, phosphates, albumin, lactate and arterial blood gases. Results. - After CPB respiratory acidosis was observed. There was a significant increase of chloride with a decrease in apparent strong ion difference (SIDa). At the same time bicarbonate and base excess (BE) remained constant. A significant but weak correlation between BE and SIDa existed (r(2) = 0.06, p = 0.024). On the contrary, no correlation was found between variations of BE and SIDa. However, the correlation was stronger between values and variations of bicarbonate and BE (respectively r(2) = 0.605, p < 0.0001 and r(2)-0.495, p < 0.0001). Conclusion. - No metabolic acidosis occurred after cardiac surgery when CPB was primed with bicarbonate. Therefore, it appears that chloride administration is not the main mechanism being involved in the acid-base regulation. This reinforces the hypothesis that metabolic acidosis during CPB may mainly be due to dilution of bicarbonate. (c) 2006 Elsevier Masson SAS. Tons droits reserves.
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页码:10 / 16
页数:7
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