高氧对心脏手术患者预后影响的研究进展
Research Progress on the Effect of Hyperoxia on the Prognosis of Patients Undergoing Cardiac Surgery
摘要: 心脏手术中会常规使用超生理水平的高氧,特别是在体外循环(Cardiopulmonary Bypass, CPB)期间,以防止手术和/或CPB引起的非生理性细胞缺氧。然而高氧对心脏手术患者的术后不利影响表明这种做法可能是有害的。本文系统综述了高氧在心脏手术中使用的风险,从高氧的氧化应激和心血管效应的损伤生理机制展开讨论,并根据国内外最新的临床证据分析高氧对心脏手术患者术后心肌损伤、肺部并发症、急性肾损伤、神经系统并发症及溶血与出血的发生风险的影响,以便为临床早期干预和改善患者预后提供理论依据。
Abstract: Supraphysiological levels of hyperoxia are routinely used during cardiac surgery, especially during cardiopulmonary bypass (CPB), to prevent non-physiologic cellular hypoxia induced by surgery and/or CPB. However, the adverse postoperative effects of hyperoxia in patients undergoing cardiac surgery suggest that this practice may be harmful. This article systematically reviews the risks of hyperoxia use in cardiac surgery, discusses the oxidative stress of hyperoxia and the damage physi-ological mechanism of cardiovascular effects, and analyzes the effects of hyperoxia on postoperative myocardial injury, pulmonary complications, acute kidney injury, nervous system complications, and the risk of hemolysis and hemorrhage in patients undergoing cardiac surgery according to the latest clinical evidence at home and abroad, in order to provide a theoretical basis for early clinical intervention and improve the prognosis of patients.
文章引用:左亚群, 宋鑫宇, 陈哲平, 金延武. 高氧对心脏手术患者预后影响的研究进展[J]. 临床医学进展, 2024, 14(3): 1034-1041. https://doi.org/10.12677/ACM.2024.143806

参考文献

[1] Spoelstra-de Man, A.M.E., Smit, B., Oudemans-van Straaten, H.M. and Smulders, Y.M. (2015) Cardiovascular Effects of Hyperoxia during and after Cardiac Surgery. Anaesthesia, 70, 1307-1319. [Google Scholar] [CrossRef] [PubMed]
[2] Martin, D.S. and Grocott, M.P.W. (2015) Oxygen Therapy and Anaesthe-sia: Too Much of a Good Thing? Anaesthesia, 70, 522-527. [Google Scholar] [CrossRef] [PubMed]
[3] Vilalta, A., Sahuquillo, J., Merino, M.-A., Poca, M.-A., Garnacho, A., Martínez-Valverde, T. and Dronavalli, M. (2011) Normobar-ic Hyperoxia in Traumatic Brain Injury: Does Brain Metabolic State Influence the Response to Hyperoxic Challenge? Journal of Neurotrauma, 28, 1139-1148. [Google Scholar] [CrossRef] [PubMed]
[4] Koning, N.J., Simon, L.E., Asfar, P., Baufreton, C. and Boer, C. (2014) Systemic Microvascular Shunting through Hyperdynamic Capillaries after Acute Physiological Disturbances Following Cardiopulmonary Bypass. The American Journal of Physiology-Heart and Circulatory Physiology, 307, H967-H975. [Google Scholar] [CrossRef] [PubMed]
[5] Boisramé-Helms, J., Radermacher, P. and Asfar, P. (2016) Car-diac Surgery, a Right Target for Hyperoxia? Critical Care, 20, Article No. 162. [Google Scholar] [CrossRef] [PubMed]
[6] Dyson, A., Stidwill, R., Taylor, V. and Singer, M. (2009) The Impact of Inspired Oxygen Concentration on Tissue Oxygenation during Progressive Haemorrhage. Intensive Care Medicine, 35, 1783-1791. [Google Scholar] [CrossRef] [PubMed]
[7] Damiani, E., Donati, A. and Girardis, M. (2018) Oxygen in the Critically Ill: Friend or Foe? Current Opinion in Anesthesiology, 31, 129-135. [Google Scholar] [CrossRef
[8] Sanders, S.P., Zweier, J.L., Kuppusamy, P., Harrison, S.J., Bassett, D.J., Gabrielson, E.W. and Sylvester, J.T. (1993) Hyperoxic Sheep Pulmonary Microvascular Endothelial Cells Generate Free Radicals via Mitochondrial Electron Transport. Journal of Clinical Investigation, 91, 46-52. [Google Scholar] [CrossRef
[9] Turrens, J.F., Freeman, B.A. and Crapo, J.D. (1982) Hyperoxia Increases H2O2 Release by Lung Mitochondria and Microsomes. Archives of Biochemistry and Biophysics, 217, 411-421. [Google Scholar] [CrossRef] [PubMed]
[10] Smit, B., Smulders, Y.M., Van Der Wouden, J.C., Oudemans-van Straaten, H.M. and Spoelstra-de Man, A.M.E. (2018) Hemodynamic Effects of Acute Hyperoxia: Sys-tematic Review and Meta-Analysis. Critical Care, 22, Article No. 45. [Google Scholar] [CrossRef] [PubMed]
[11] Watson, N.A., Beards, S.C., Altaf, N., Kassner, A. and Jackson, A. (2000) The Effect of Hyperoxia on Cerebral Blood Flow: A Study in Healthy Volunteers Using Magnetic Resonance Phase-Contrast Angiography. European Journal of Anaesthesiology, 17, 152-159. [Google Scholar] [CrossRef
[12] Fallon, T.J., Maxwell, D. and Kohner, E.M. (1985) Ret-inal Vascular Autoregulation in Conditions of Hyperoxia and Hypoxia Using the Blue Field Entoptic Phenomenon. Ophthalmology, 92, 701-705. [Google Scholar] [CrossRef
[13] Gonzalez-Alonso, J., Richardson, R.S. and Saltin, B. (2001) Exercising Skeletal Muscle Blood Flow in Humans Responds to Reduction in Arterial Oxyhaemoglobin, but Not to Al-tered Free Oxygen. The Journal of Physiology, 530, 331-341. [Google Scholar] [CrossRef] [PubMed]
[14] Rousseau, A., Bak, Z., Janerot-Sjoberg, B. and Sjoberg, F. (2005) Acute Hyperoxaemia-Induced Effects on Regional Blood Flow, Oxygen Consumption and Central Circulation in Man. Acta Physiologica Scandinavica, 183, 231-240. [Google Scholar] [CrossRef
[15] McNulty, P.H., Robertson, B.J., Tulli, M.A., Hess, J., Harach, L.A., Scott, S. and Sinoway, L.I. (2007) Effect of Hyperoxia and Vitamin C on Coronary Blood Flow in Patients with Ischemic Heart Disease. Journal of Applied Physiology (Bethesda, Md.: 1985: Online), 102, 2040-2045. [Google Scholar] [CrossRef] [PubMed]
[16] Smit, B., Smulders, Y.M., Eringa, E.C., Oudemans-van Straaten, H.M., Girbes, A.R.J., Wever, K.E., Hooijmans, C.R. and Spoelstra-de Man, A.M.E. (2018) Effects of Hy-peroxia on Vascular Tone in Animal Models: Systematic Review and Meta-Analysis. Critical Care, 22, Article No. 189. [Google Scholar] [CrossRef] [PubMed]
[17] Modun, D., Krnic, M., Vukovic, J., Kokic, V., Kukoc-Modun, L., Tsikas, D. and Dujic, Z. (2012) Plasma Nitrite Concentration Decreases after Hyperoxia-Induced Oxidative Stress in Healthy Humans. Clinical Physiology and Functional Imaging, 32, 404-408. [Google Scholar] [CrossRef
[18] Farquhar, H., Weatherall, M., Wijesinghe, M., Perrin, K., Ranchord, A., Simmonds, M. and Beasley, R. (2009) Systematic Review of Studies of the Effect of Hyperoxia on Coro-nary Blood Flow. American Heart Journal, 158, 371-377. [Google Scholar] [CrossRef] [PubMed]
[19] Young, R.W. (2012) Hyperoxia: A Review of the Risks and Bene-fits in Adult Cardiac Surgery. The Journal of ExtraCorporeal Technology, 44, 241-249. [Google Scholar] [CrossRef
[20] Angelos, M.G., Yeh, S.T. and Aune, S.E. (2011) Post-Cardiac Arrest Hyperoxia and Mitochondrial Function. Resuscitation, 82, S48-S51. [Google Scholar] [CrossRef
[21] De Nicolo, B., Cataldi-Stagetti, E., Diquigiovanni, C. and Bonora, E. (2023) Calcium and Reactive Oxygen Species Signaling Interplays in Cardiac Physiology and Pathologies. Antioxidants, 12, Article No. 353. [Google Scholar] [CrossRef] [PubMed]
[22] Peng, Y.-W., Mohammed, A., Deatrick, K.B., Major, T., Cheng, D., Charpie, I. and Charpie, J.R. (2019) Differential Effects of Normoxic and Hyperoxic Reperfusion on Global Myocardial Ischemia-Reperfusion Injury. Seminars in Thoracic and Cardiovascular Surgery, 31, 188-198. [Google Scholar] [CrossRef] [PubMed]
[23] Sinclair, D.G., Haslam, P.L., Quinlan, G.J., Pepper, J.R. and Evans, T.W. (1995) The Effect of Cardiopulmonary Bypass on Intestinal and Pulmonary Endothelial Permeability. Chest, 108, 718-724. [Google Scholar] [CrossRef] [PubMed]
[24] Dias-Freitas, F., Metelo-Coimbra, C. and Roncon-Albuquerque, R. (2016) Molecular Mechanisms Underlying Hyperoxia Acute Lung Injury. Respiratory Medicine, 119, 23-28. [Google Scholar] [CrossRef] [PubMed]
[25] Verona, C., Hackenhaar, F.S., Teixeira, C., Medeiros, T.M., Ala-barse, P.V., Salomon, T.B., Shüller, Á.K., Maccari, J.G., Condessa, R.L., Oliveira, R.P., Rios Vieira, S.R. and Benfato, M.S. (2015) Blood Markers of Oxidative Stress Predict Weaning Failure from Mechanical Ventilation. Journal of Cellu-lar and Molecular Medicine, 19, 1253-1261. [Google Scholar] [CrossRef] [PubMed]
[26] Ihnken, K., Winkler, A., Schlensak, C., Sarai, K., Neidhart, G., Unkel-bach, U., Mülsch, A. and Sewell, A. (1998) Normoxic Cardiopulmonary Bypass Reduces Oxidative Myocardial Damage and Nitric Oxide during Cardiac Operations in the Adult. The Journal of Thoracic and Cardiovascular Surgery, 116, 327-334. [Google Scholar] [CrossRef
[27] Jakutis, G., Norkienė, I., Ringaitienė, D. and Jovaiša, T. (2017) Severity of Hyperoxia as a Risk Factor in Patients Undergoing On-Pump Cardiac Surgery. Acta Medica Lituanica, 24, 153-158. [Google Scholar] [CrossRef] [PubMed]
[28] Douin, D.J., Pattee, J., Scott, B., Fernandez-Bustamante, A., Prin, M., Eckle, T., Ginde, A.A. and Clendenen, N. (2023) Hyperoxemia during Cardiac Surgery Is Associated with Postoperative Pulmonary Complications. Critical Care Explorations, 5, e0878. [Google Scholar] [CrossRef
[29] Kelava, M., Milam, A.J., Mi, J., Alfirevic, A., Grady, P., Unai, S., Elgharably, H., McCurry, K., Koprivanac, M. and Duncan, A. (2023) Arterial Hyperoxemia during Cardiopul-monary Bypass Was Not Associated with Worse Postoperative Pulmonary Function: A Retrospective Cohort Study. An-esthesia & Analgesia. [Google Scholar] [CrossRef
[30] Kallet, R.H. and Matthay, M.A. (2013) Hyperoxic Acute Lung Injury. Respiratory Care, 58, 123-141. [Google Scholar] [CrossRef] [PubMed]
[31] Pizov, R., Weiss, Y.G., Oppenheim-Eden, A., Glickman, H., Good-man, S., Koganov, Y., Barak, V., Merin, G. and Kramer, M.R. (2000) High Oxygen Concentration Exacerbates Cardio-pulmonary Bypass-Induced Lung Injury. Journal of Cardiothoracic and Vascular Anesthesia, 14, 519-523. [Google Scholar] [CrossRef] [PubMed]
[32] Heinrichs, J. and Grocott, H.P. (2019) Pro: Hyperoxia Should Be Used during Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia, 33, 2070-2074. [Google Scholar] [CrossRef] [PubMed]
[33] Roberts, S.M. and Cios, T.J. (2019) Con: Hyperoxia Should Not Be Used Routinely in the Management of Cardiopulmonary Bypass. Journal of Cardiothoracic and Vascular Anesthesia, 33, 2075-2078. [Google Scholar] [CrossRef] [PubMed]
[34] Topcu, A.C., Bolukcu, A., Ozeren, K., Kavasoglu, T. and Kayacioglu, I. (2021) Normoxic Management of Cardiopulmonary Bypass Reduces Myocardial Oxidative Stress in Adult Patients Undergoing Coronary Artery Bypass Graft Surgery. Perfusion, 36, 261-268. [Google Scholar] [CrossRef] [PubMed]
[35] Smit, B., Smulders, Y.M., De Waard, M.C., Boer, C., Vonk, A.B.A., Veerhoek, D., Kamminga, S., De Grooth, H.-J.S., García-Vallejo, J.J., Musters, R.J.P., Girbes, A.R.J., et al. (2016) Moderate Hyperoxic versus Near-Physiological Oxygen Targets during and after Coronary Artery Bypass Sur-gery: A Randomised Controlled Trial. Critical Care, 20, Article No. 55. [Google Scholar] [CrossRef] [PubMed]
[36] Abou-Arab, O., Huette, P., Martineau, L., Beauvalot, C., Beyls, C., Josse, E., Touati, G., Bouchot, O., Bouhemad, B., Diouf, M., Lorne, E. and Guinot, P.-G. (2019) Hyperoxia during Cardiopulmonary Bypass Does Not Decrease Cardiovascular Complications Following Cardiac Surgery: The CARDIOX Randomized Clinical Trial. Intensive Care Medicine, 45, 1413-1421. [Google Scholar] [CrossRef] [PubMed]
[37] Inoue, T., et al. (2002) Cardioprotective Effects of Lowering Oxygen Tension after Aortic Unclamping on Cardiopulmonary Bypass during Coronary Artery Bypass Grafting. Circu-lation Journal, 66, 718-722. [Google Scholar] [CrossRef] [PubMed]
[38] Lee, J.-S., Kim, J.-C., Chung, J.-Y., Hong, S.-W., Choi, K.-H. and Kwak, Y.-L. (2010) Effect of Arterial Oxygen Tension during Reperfusion on Myocardial Recovery in Patients Undergoing Valvular Heart Surgery. Korean Journal of Anesthesiology, 58, 122-128. [Google Scholar] [CrossRef] [PubMed]
[39] Shen, Y., Ru, W., Cao, L., Jiang, R. and Xu, X. (2022) Impact of Partial Pressure of Oxygen Trajectories on the Incidence of Acute Kidney Injury in Patients Undergoing Cardiopulmo-nary Bypass. Journal of Cardiology, 79, 545-550. [Google Scholar] [CrossRef] [PubMed]
[40] Kraus, A.C. and De Miguel, C. (2022) Hyperoxia and Acute Kidney Injury: A Tale of Oxygen and the Kidney. Seminars in Nephrology, 42, Article ID: 151282. [Google Scholar] [CrossRef] [PubMed]
[41] Toraman, F., Evrenkaya, S., Senay, S., Karabulut, H. and Alhan, C. (2007) Adjusting Oxygen Fraction to Avoid Hyperoxemia during Cardiopulmonary Bypass. Asian Cardio-vascular and Thoracic Annals, 15, 303-306. [Google Scholar] [CrossRef] [PubMed]
[42] McGuinness, S.P., Parke, R.L., Drummond, K., Willcox, T., Bailey, M., Kruger, C., Baker, M., Cowdrey, K.-A., Gilder, E., McCarthy, L., Painter, T. and SO-COOL Investigators (2016) A Multicenter, Randomized, Controlled Phase IIb Trial of Avoidance of Hyperoxemia during Cardiopulmonary Bypass. Anesthesiology, 125, 465-473. [Google Scholar] [CrossRef
[43] Bae, J., Kim, J., Lee, S., Ju, J.-W., Cho, Y.J., Kim, T.K., Jeon, Y. and Nam, K. (2021) Association between Intraoperative Hyperoxia and Acute Kidney Injury after Cardiac Sur-gery: A Retrospective Observational Study. Journal of Cardiothoracic and Vascular Anesthesia, 35, 2405-2414. [Google Scholar] [CrossRef] [PubMed]
[44] Nam, K., Nam, J.-S., Kim, H.-B., Chung, J., Hwang, I.E., Ju, J.-W., Bae, J., Lee, S., Cho, Y.J., Shim, J.-K., Kwak, Y.-L., Chin, J.-H., Choi, I.-C., Lee, E.-H. and Jeon, Y. (2023) Effects of Intraoperative Inspired Oxygen Fraction (FiO2 0.3 vs 0.8) on Patients Undergoing off-Pump Coronary Artery Bypass Grafting: The CARROT Multicenter, Cluster-Randomized Trial. Critical Care, 27, Article No. 286. [Google Scholar] [CrossRef] [PubMed]
[45] Sauër, A.C., Veldhuijzen, D.S., Ottens, T.H., Slooter, A.J.C., Kalkman, C.J. and van Dijk, D. (2017) Association between Delirium and Cognitive Change after Cardiac Surgery. Brit-ish Journal of Anaesthesia, 119, 308-315. [Google Scholar] [CrossRef] [PubMed]
[46] Kupiec, A., Adamik, B., Forkasiewicz-Gardynik, K. and Goździk, W. (2020) Intra-Operative Hyperoxia and the Risk of Delirium in Elderly Patients after Cardiac Surgery. Aging, 12, 7006-7014. [Google Scholar] [CrossRef] [PubMed]
[47] Lopez, M.G., Pandharipande, P., Morse, J., Shotwell, M.S., Milne, G.L., Pretorius, M., Shaw, A.D., Roberts, L.J. and Billings, F.T. (2017) Intraoperative Cerebral Oxygena-tion, Oxidative Injury, and Delirium Following Cardiac Surgery. Free Radical Biology and Medicine, 103, 192-198. [Google Scholar] [CrossRef] [PubMed]
[48] Shaefi, S., Shankar, P., Mueller, A.L., O’Gara, B.P., Spear, K., Khabbaz, K.R., Bagchi, A., Chu, L.M., Banner-Goodspeed, V., Leaf, D.E., Talmor, D.S., Marcantonio, E.R. and Subramaniam, B. (2021) Intraoperative Oxygen Concentration and Neurocognition after Cardiac Surgery. Anesthesi-ology, 134, 189-201. [Google Scholar] [CrossRef
[49] Fontes, M.T., McDonagh, D.L., Phil-lips-Bute, B., Welsby, I.J., Podgoreanu, M.V., Fontes, M.L., Stafford-Smith, M., Newman, M.F., Mathew, J.P. and Neurologic Outcome Research Group (NORG) of the Duke Heart Center (2014) Arterial Hyperoxia during Cardiopul-monary Bypass and Postoperative Cognitive Dysfunction. Journal of Cardiothoracic and Vascular Anesthesia, 28, 462-466. [Google Scholar] [CrossRef] [PubMed]
[50] Abou-Arab, O., Huette, P., Guilbart, M., Dupont, H. and Guinot, P.-G. (2020) Hyperoxia during Cardiopulmonary Bypass Does Not Increase Respiratory or Neurological Com-plications: A Post Hoc Analysis of the CARDIOX Study. British Journal of Anaesthesia, 125, e400-e401. [Google Scholar] [CrossRef] [PubMed]
[51] Gretchen, C., Bayir, H., Kochanek, P.M., Ruppert, K., Viegas, M., Palmer, D. and Kim-Campbell, N. (2022) Association between Hyperoxemia and Increased Cell-Free Plasma Hemoglo-bin during Cardiopulmonary Bypass in Infants and Children. Pediatric Critical Care Medicine, 23, e111-e119. [Google Scholar] [CrossRef
[52] Yilmaz Ak, H., Özşahin, Y., Yeşiltaş, M.A., Sandal, B., Sa-lihoglu, Z. and Erkalp, K. (2022) Early Outcomes of a High PaO2/FiO2 Ratio during Cardiopulmonary Bypass. The Journal of Tehran University Heart Center, 17, 41-47. [Google Scholar] [CrossRef] [PubMed]