Wpływ śródoperacyjnej hemodilucji na stężenia endogennych amin katecholowych podczas rewaskularyzacji krążenia wieńcowego

Wojciech Dąbrowski¹, Ziemowit Rzecki¹, Marek Czajkowski², Janusz Stążka², Andrzej Nestorowicz¹

Summary
Background. Normovolemic haemodilution during cardiopulmonary bypass is associated with increased catecholamine release, in response to the rapid decrease in haemoglobin concentration and changes in serum osmolality. We have assessed changes in epinephrine, norepinephrine and dopamine concentrations in 15 patients undergoing coronary artery bypass surgery. Methods. Patients were allocated to two groups according to their body weight: group A 55-75 kg and group B 76-103 kg. In both groups the same priming volume was used. Catecholamine concentrations were measured before anaesthesia, during bypass and haemodilution, immediately after surgery, and at 24 and 48 hrs after surgery. Results. In group A, concentrations of all three catecholamines increased significantly during haemodilution. Dopamine remained elevated immediately after surgery, then returned to normal, and norepinephrine increased during the first 24 hrs after surgery. In group B, only dopamine concentration decreased during surgery. Conclusions. Since significant catecholamine release was observed in the low body weight patients only, it seems to be associated with the degree of haemodilution. Therefore, the priming volume and degree of haemodilution should be adjusted to the patient´s body weight.

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