[Estimation of peripheral metabolism under cardiopulmonary bypass by measuring ketone bodies, lactate, and pyruvate].
Both ketone body ratio (KBR) and pyruvate/lactate ratio (P/L) are metabolic indicators related to NAD-linked dehydrogenase system according to the REDOX THEORY. In order to estimate the peripheral metabolic state under the cardiopulmonary bypass (CPB) which is considered to be a moderate and controllable shock state, we measured the pyruvate (P), lactate (L) and ketone bodies (acetoacetate [ACA], 3-hydroxybutyrate[HOB]) pre, during, and post-CPB in 20 open heart surgical patients (Group 1). We also measured ketone bodies in another group (Group 2: 22 patients) of elective coronary artery bypass surgery (CABG). Five patients in Group 2 who developed postoperative organ failure (Group 2-A) were compared with the other 17 cases with uneventful postoperative course (Group 2-B). In Group 1, P and L concentrations progressively increased until the end of CPB, thereafter decreased (P less than 0.001). HOB and TKB significantly increased immediately after the start of CPB, afterward which declined during CPB and returned to the control level after CPB. Both KBR and P/L regression analysis reveal the significant correlation between P/L and KBR (r = 0.51, P less than 0.001). KBR at 1 hour after CPB returned to the control level, however, P/L at 1 hour after CPB still stayed in the significant lower level than the control (P less than 0.001). KBR at the aortic declamping in group 2-A was significantly lower than that in group 2-B. In conclusion, P/L and KBR changed in relation to hemodynamic change during CPB.(ABSTRACT TRUNCATED AT 250 WORDS)
Handa
N
N
First Department of Surgery, Saitama Medical School, Japan.
Kyo
S
S
Arai
Y
Y
Komoda
T
T
Yokote
Y
Y
Sakagishi
Y
Y
Omoto
R
R
D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D007657:Ketone Bodies / Q000378:metabolism*; D007773:Lactates / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000378:metabolism; D011773:Pyruvates / Q000378:metabolism*; D012044:Regression Analysis
D007657:Ketone Bodies; D007773:Lactates; D011773:Pyruvates