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KMID : 0382619850050010227
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Hanyang Journal of Medicine
1985 Volume.5 No. 1 p.227 ~ p.240
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Clinical Study of Changes in 2,3-Diphosphoglycerate Concentration during Open Heart Surgery with Extracorporeal Circulation.
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Abstract
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The derangement of blood flow due to increased shunt and decreased cardiac out-put may be a characteristic of congenital heart disease and a threat to a life accompa-nying with the impairment of oxygen supply to the vital organs and peripheral tissues.
Therefore, open heart surgery under extracorporeal circulation has been perform-ed to minimize the derangement of blood flow. It has been noted not only various beneficial outcomes but also increasing tendency of the surgery and decreasing of the complications.
It is said that the amount of oxygen supplied to the vital organs and the peripheral tissues after open heart surgery may be an important role in determining the pro-gnosis of the patient.
The hemoglobin oxygen dissociation curve has been used not only as an indicator of oxygen carrying capacity to vital organs and peripheral tissues but also affected by acid base equilibrium, temperature, PaCO2 and 2,3 diphosphoglycerate concen-tration in arterial blood. The concentration of 2,3 DPG has been a factor to change the hemoglobin oxygen affinity. In congenital heart disease, the increased 2,3 DPG concentration was noted as a compensation and therefore, oxygen carrying capacity to vital organs and peripheral tissues was enhanced as a result of decreased hemoglobin oxygen affinity.
Nevertheless, changes of hemoglobin concentration, Pa02, pH, Ca02 and 2,3 DPG concentration in arterial blood were seen due to hemodilution of prime solution and mechanical factor of heart lung machine in open heart surgery under extracorporeal circulation.
To clarify the correlations of these changes, hemoglobin concentration, Pa02, pH, Ca02 and 2,3 DPG concentration in arterial blood were comparatively analysed at several times: before and 20 minutes after extracorporeal circulation, recovery room, 2nd days and 7th days after open heart surgery.
The results were as follows:
1. The correlation between the changes of 2,3 DPG concentration and hemoglobin concentration in arterial blood was not seen after extracorporeal circulation.
2. The changes of 2,3 DPG concentration and Pa02 in arterial blood was noted after extracorporeal circulation without correlation.
3. The pH in arterial blood increased after extracorporeal circulation but the correla-tion with the change of 2,3 DPG concentration was not obtained.
4. The correlation between the changes of Pa02 and 2,3 DPG concentration in arterial blood was not seen after extracorporeal circulation.
5. A decrease of 2,3 DPG concentration in arterial blood to 0.972 μmol/ml at 20 minutes after extracorporeal circulation was thought to be an effect of oxygenator and hypothermia technique which was used during extracorporeal circulation.
6. The correlation among the changes of 2,3 DPG concentration, hemoglobin con-centration, PaO2, pH, Ca02 in arterial blood, was noted before extracorporeal cir-culation. But it was not obtained after extracorporeal circulation. It may be a result of a disturbance in physiologic equilibrium by extracorporeal circulation.
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