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The Journal of Cardiovascular Surgery 1999 April;40(2):191-5

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Impaired ­lung oxy­gen­a­tion in ­acute ­aortic dis­sec­tion

Hasegawa Y., Ishikawa S., Ohtaki A., Otani Y., Takahashi T., Sato Y., Koyano T., Yamagishi T., Ohki S., Kanda T. *, Morishita Y.

From the ­Second Depart­ment of Sur­gery and * Depart­ment of Labor­a­tory Med­i­cine Gunma Uni­ver­sity ­School of Med­i­cine Mae­bashi, ­Japan


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Back­ground. In the ­early ­phase ­after the ­onset of ­acute ­aortic dis­sec­tion, oxy­gen­a­tion impair­ment ­often ­occurs. How­ever, the eti­ology and clin­ical ­course of ­this phe­nom­enon ­have not ­been estab­lished. We exam­ined the ­serial ­changes of oxy­gen­a­tion, inflam­ma­tory reac­tion and labor­a­tory ­data in ­patients ­with ­acute ­aortic dis­sec­tion.
­Methods. ­Nine ­patients (­DeBakey ­type I; 4, ­type II; 3 and ­type ­IIIb; 2), ­aged 46 to 82 ­years ­were ­included in ­this ­study. All ­patients ­were man­aged in the inten­sive ­care ­unit, and sys­tolic arte­rial pres­sure was main­tained at ­around 110 to 120 ­mmHg. Oxy­gen­a­tion was ­impaired in all ­patients, ­three (33%) of ­whom ­required mechan­ical ven­til­a­tory sup­port.
­Results. ­Pleural effu­sion was ­observed in ­eight (89%) of ­nine ­patients. Res­pir­a­tory ­index was 0.98±0.19 (­mean ± SEM) at the ­time of admis­sion, and ele­vated to 1.59±0.35, 1.58±0.21, 1.60±0.28 respec­tively, at day 1, 2 and 3. Oxy­gen­a­tion ­index was 318±34 at the ­time of admis­sion, and ­decreased to 271±34, 255±19, 263±26, respec­tively, at day 1, 2 and 3. ­These ­values recov­ered to ­normal ­after day 4. The ­increase of ­white ­blood ­cells and ­high ­fever (>38°C) con­tinued ­until day 3. ­Platelet ­counts recov­ered ­after day 4. The ­serum bilir­ubin ­level was ­highest (2.0±0.5 mg/dl) at day 3, and ­decreased grad­u­ally ­after day 4. In two ­recent ­patients ­whose ­serum inter­leukin-8 (IL-8) was meas­ured, IL-8 ­levels ­increased ­according to the ­impaired oxy­gen­a­tion or aneu­rysmal enlarge­ment. ­Impaired oxy­gen­a­tion, inflam­ma­tory ­changes, ­platelet con­sump­tion and bilir­ubin ele­va­tion con­tinued ­until day 3 and ­resumed ­normal ­levels ­after day 4.
Con­clu­sions. ­These ­changes may be due to hemol­ysis, con­sump­tion coag­u­lop­athy or inflam­ma­tion asso­ciated ­with ­acute ­aortic dis­sec­tion. IL-8 ele­va­tion may be asso­ciated ­with aneu­rysmal enlarge­ment and ­these phe­nomena.

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