Authors:
Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation,
Rublevskoe shosse, 135, Moscow, 121552, Russian Federation
E-mail: Сведения доступны для зарегистрированных пользователей.
DOI:
UDC: 616.12-007.1-089:615.211
Link: Clinical Physiology of Blood Circulaiton. 2019; 16 (2): 115-123
Quote as: Yudin G.V., Rybka M.M., Khinchagov D.Ya., Solov'ev N.A., Lomakin M.V., Aydashev Yu.Yu. The effect of inotropic support of adrenaline on the severity of metabolic disorders in patients operated on the heart valves. Clinical Physiology of Circulation. 2019; 16 (2): 115–23 (in Russ.). DOI: 10.24022/1814-6910-2019-16-2-115-123
Received / Accepted: February 11, 2019 / February 12, 2019
DownloadObjective. To study the effect of adrenaline infusion on the severity of hyperglycemia, hyperlactatemia and metabolic acidosis in the intraoperative period and in the first postoperative day in patients operated on heart valves.
Material and methods. The study is randomized, prospective, single-center. It included patients with heart valves diseases, divided into two groups: the adrenaline group of 37 patients, the dobutamine group of 33 patients. The dynamics and severity of glycemia, lactatemia and metabolic acidosis, the duration of respiratory support and the length of stay of patients in the intensive care unit were studied.
Results. The maximum level of glycemia was observed from the 6th to the 12th hours of the early postoperative period in patients of both groups and had the highest values in the epinephrine group, 15.8±0.7 mmol/l versus 11.8±0.5 mmol/l in the dobutamine group (p<0.05). In the group of adrenaline in the post-perfusion period and during the first postoperative day there was hyperlactatemia with maximum values of lactate concentration of 8.7±4.2 mmol/l from the 6th to the 12th hours of the postoperative period, which was not observed in the group of dobutamine, where lactate did not exceed 2.3±1.1 mmol/l (p<0.01). The frequency of metabolic acidosis prevailed in the group of adrenaline from the 3rd to the 9th hours (p<0.05). The duration of mechanical ventilation was significantly longer in the adrenalin group, 16±8 hours versus 12±6 hours in the dobutamine group (p<0.01).
Conclusion. In patients, operated on heart valves, inotropic support of adrenaline increases hyperglycemia and provokes the development of hyperlactatemia with metabolic acidosis in the first postoperative day, while hyperlactatemia is transient. In comparison with dobutamine, inotropic therapy with adrenaline affects the increase of the duration of respiratory support.
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Gennadiy V. Yudin, Anesthesiologist; orcid.org/0000-0001-9976-6206
Mikhail M. Rybka, Dr. Med. Sc., Head of Department of Anesthesiology; orcid.org/0000-0001-8206-8794
Dzhumber Ya. Khinchagov, Cand. Med. Sc., Anesthesiologist
Nikolay A. Solov'ev, Postgraduate
Maksim V. Lomakin, Anesthesiologist
Yuriy Yu. Aydashev, Anesthesiologist