title: [Gastrointestinal hemorrhage in cardiosurgery in patients with endothelial dysfunction].
abstract: OBJECTIVE
  To estimate the prognostic value of the hypoxic test, intragastric pH-metry, and endothelial dysfunction in cardiosurgical patients at risk of gastrointestinal hemorrhage.
  
  
  METHODS
  This prospective study approved by the ethical committee was performed based at the Department of Anesthesiology and Resuscitation, Research Institute of Cardiology, Tomsk, in 2012-2013. It included 30 patients who had previously undergone myocardial revascularization with artificial circulation. Gastroduodenal complications were predicted based on the results of the general hypoxic test, monitoring intragastric pH, and determination of endothelial function markers (endothelin-1, nitric oxide metabolites) intra- and postoperatively.
  
  
  RESULTS
  17 (56.7%) patients with negative results of hypoxic test were referred to the group at low-risk of gastrointestinal complications and given no antisecretory therapy. Plasma ET-1 level in the patients with gastric hemorrhage was almost 10 times that in the absence of complications. Multiple organ insufficiency was associated with a rise in RT-1 levels by the end of the first postoperative day. High ET-1 levels suggested the predominance of vasoconstrictive effect that eventually resulted in a break of the vascular wall and hypoperfusion of gastric mucosa.
  
  
  CONCLUSIONS
  High ET-1 levels and disbalance of nitric oxide metabolites in blood are the main predictors of postoperative complications that characterize the functional state of vascular endothelium and may cause vascular rupture in case of the atherosclerotic process. The use of hypoxic test and gastric pH-metry in the preoperative period make it possible to distinguish patients that do not need preventive antisecretory therapy.
authors.forename: I A
authors.initials: IA
authors.lastname: Mandel'
authors.forename: I V
authors.initials: IV
authors.lastname: Sukhodolo
authors.forename: R I
authors.initials: RI
authors.lastname: Pleshko
authors.forename: A A
authors.initials: AA
authors.lastname: Anishchuk
authors.forename: V O
authors.initials: VO
authors.lastname: Kiselev
authors.forename: Iu K
authors.initials: IuK
authors.lastname: Podoksenov
authors.forename: V M
authors.initials: VM
authors.lastname: Shipulin
authors.forename: L S
authors.initials: LS
authors.lastname: Liapinova
authors.forename: A E
authors.initials: AE
authors.lastname: Nevdakh
mesh_terms: D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D019332:Endothelin-1 / Q000097:blood; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006331:Heart Diseases / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies
chemical_list: D019332:Endothelin-1; D009569:Nitric Oxide