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Perioperatives myokardiales Monitoring von bypassoperierten Patienten

Myocardial metabolism during CABG

  • ORIGINALARBEIT
  • Published:
Intensivmedizin und Notfallmedizin

Abstract

Background

Microdialysis allows the biochemical analysis of interstitial fluids. We investigated the dynamic changes of myocardial metabolism from patients with ischemic heart disease and with low left ventricular ejection fraction (EF <50%).

Methods

In 30 patients undergoing coronary artery bypass grafting, a microdialysis catheter was inserted in the left heart in an area of abnormal ventricular contraction. A second catheter was placed in the normal tissue of the right ventricle. Microdialysis measurements were performed in the perioperative course.

Results

During CBP both ventricles showed signs of poor tissue oxygenation. The glucose-lactate ratio (GLQ) as a marker of nutritional disorder of the right ventricle had significantly better values at this point. Glycerol was significantly higher in the left myocardium. The postoperatively increased lactate-pyruvate ratio of three patients was associated with acute myocardial infarction.

Conclusions

Conclusions GLQ and glycerol values as markers of anaerobic metabolism and cell membrane desintregity, respectively, showed signs of rising in both ventricles during cardioplegic arrest, but were significantly higher in the left ventricle due to underlying ischemic coronary disease. Myocardial microdialysis is an useful tool in rapid intraoperative detection of ischemia.

Zusammenfassung

Einige Patienten weisen ein erhöhtes Risiko auf, in der frühpostoperativen Phase nach aortokoronarer Bypassoperation ein Pumpversagen zu erleiden. Es besteht das klinische Interesse, das allgemeine systemische Stoffwechselmonitoring auf den direkten zellulären Stoffwechsel des Herzens zu erweitern. Mit dem Verfahren der Mikrodialyse besteht die Möglichkeit, in allen Geweben Stoffwechselveränderungen semikontinuierlich auf zellulärer Ebene zu erfassen.

Mikrodialysekatheter wurden in ein dyskinetische Segment des linken Ventrikels und in ein normokontraktäres Areal der rechten Kammer platziert. Es wurden myokardiale Glucose-, Pyruvat-, Glycerol- und Latatkonzentrationen bestimmt und hieraus anschließend der Laktat-Glucose-Quotient (GLQ) sowie der Laktat-Pyruvat-Quotient (LP) ermittelt.

Die Glycerolkonzentration erreichten währen der Aorten klemmzeit signifikant in den dyskinetischen Segmenten deutlich höhere Werte (Glycerol: 146±67 μmol/l vs. 72±36 μmol/l). Der GLQ erzielte im Bereich der normokontraktilen Gebiete der Klemmzeit deutlich bessere Werte (1,46±0,75 μmol/l vs. 0,61±0,25). Frühpostoperativ zeigten beide Ventrikel eine schnelle Erholung aller Parameter. Bei drei Patienten kam es frühpostoperativ aufgrund einer Bypassdysfunktion zu einem Wiederanstieg des LP-Quotienten (15±7 vs. 108±67) sowie zu einem erneutem Abfall des GLQ.

Diese Art der Stoffwechselüberwachung kann sehr gut geeignet sein, die bisherigen Methoden des Monitorings zu ergänzen und hinsichtlich der Diagnostik und Therapiesteuerung kritisch kranker Patienten wertvolle zusätzliche Informationen zu liefern. Es lassen sich frühzeitig Veränderungen aufdecken, obwohl das hämodynamische Monitoring oder der systemische Stoffwechsel noch unauffällig sein kann.

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Authors and Affiliations

  1. Department of Cardiac Surgery, Schüchtermann-Klinik Bad Rothenfelde, Ulmenallee 11, 49214, Bad Rothenfelde, Germany

    J. Pöling, W. Rees & H. Warnecke

  2. Department of Anesthesiology, Herz-Jesu-Krh., Münster, Germany

    S. Klaus

  3. Department of Anesthesiology, Medical University of Lübeck, Lübeck, Germany

    L. Bahlmann

  4. Institut für klinische Herz-Kreislaufforschung der Universität Witten-Herdecke, Dortmund, Germany

    J. Pöling, W. Rees & H. Warnecke

  5. Department of Anesthesiology, Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany

    N. Hübner

  6. Department of Cardiac Surgery, University of Insubria-Varese, Insubria-Varese, Italy

    V. Mantovani

  7. Klinik für Chirurgie, Herz-Jesu-Krh., Münster, Germany

    R. Horstmann

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  1. J. Pöling
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  2. W. Rees
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  3. S. Klaus
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  4. L. Bahlmann
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  5. N. Hübner
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  6. V. Mantovani
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  8. H. Warnecke
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Correspondence to J. Pöling.

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Pöling, J., Rees, W., Klaus, S. et al. Perioperatives myokardiales Monitoring von bypassoperierten Patienten. Intensivmed 44, 98–103 (2007). https://doi.org/10.1007/s00390-006-0742-x

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  • DOI: https://doi.org/10.1007/s00390-006-0742-x

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