THE ROLE OF UNEVEN BLOOD OXYGEN SATURATION AND OTHER PERFUSION PARAMETERS IN DEVELOPMENT OF HEMOLYSIS AFTER ON-PUMP CORONARY ARTERY BYPASS GRAFT SURGERY

2018

Фундаментальная и клиническая медицина, Vol 3, Iss 1, Pp 22-29 (2018)

Aim. To study parameters of extracorporeal perfusion, features of intraoperative blood oxygen saturation, and mechanisms of free radical damage of erythrocytes in patients with moderate and severe hemolysis after on-pump coronary artery bypass graft surgery. Material and Methods. The study included 73 patients with coronary artery disease with moderate (n = 48) and severe (n = 25) hemolysis developed upon the on-pump coronary artery bypass graft surgery. We evaluated duration of cardiopulmonary bypass and cardiac ischemia, intensity of coronary suction, volumetric perfusion rate, partial pressure of oxygen (pO2) and carbon dioxide (pCO2) in blood, hemoglobin oxygen saturation, and hematocrit. Before and after the surgery, we also measured plasma free hemoglobin, level of thiobarbituric acid reactive substances, and superoxide dismutase activity in erythrocytes. Results. Patients with severe hemolysis after on-pump coronary artery bypass graft surgery had 2.5-fold higher level of free hemoglobin and longer duration of cardiac ischemia compared to those with moderate hemolysis. Intraoperative hemolysis was partially defined by the duration of cardiopulmonary bypass (10.8%) and by maximum pO2 (13.4%). Before the surgery, the level of thiobarbituric acid reactive substances was increased whereas superoxide dismutase activity was reduced in erythrocytes of all patients regardless of hemolysis extent. After the surgery, such pattern was also observed in patients with moderate hemolysis. Patients with severe hemolysis had maximum pO2 > 200 mmHg, significantly higher level of thiobarbituric acid reactive substances, and elevated superoxide dismutase activity compared to preoperative values. Conclusion. Uneven blood oxygen saturation with episodes of hyperoxia can be considered as a major risk factor of severe hemolysis after on-pump coronary artery bypass graft surgery. Severe hemolysis is associated with increased superoxide dismutase activity and higher level of thiobarbituric acid reactive substances in erythrocytes, possibly due to elevated pO2 (> 200 mmHg).

article

Russian

Kemerovo State Medical University, 2018.

гемолиз, искусственное кровообращение, перфузия, гипероксия, свободнорадикальное окисление, эритроциты, hemolysis, on-pump coronary artery bypass graft surgery, perfusion, hyperoxia, free radical oxidation, erythrocytes, Medicine (General), R5-920