• Journal of Chest Surgery
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• 제40권4호
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• pp.305-308
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• 2007

Vasoplegic syndrome은 심장 수술 후 $8{\sim}10%$의 빈도로 발생하고, nitric oxide와 guanylate cyclase가 중요 역할을 하는 염증반응에 유도함에 기인하며, 높은 사망률과 유병률을 나타낸다. 본 증례에서는 수술 전 패혈증이 있던 환자에서 심폐순환 후 vasoplegenic syndrome이 발생하였다. Gguanylate cyclase 억제제인 메틸렌 블루(MB)를 투여하여 환자는 즉시 호전을 보였으며 어떠한 혈압수축제의 도움 없이도 적절한 혈압을 유지할 수 있었기에 보고한다.

• Journal of Chest Surgery
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• 제35권3호
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• pp.227-230
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• 2002

혈관확장성 쇼크(Vasodilatory shock)는 혈관마비 증후군(vasoplegic syndrome), 심폐바이패스후 혈관마비(post-cardiopulmonary bypass vasoplegia)라고도 불리며, 개심술 직후 나타나는 저혈압, 빈맥, 정상 또는 약간 증가한 심박출량 및 체혈관저항 감소 등을 특징으로 하며, 일반적인 수액공급이나 카테콜아민 혈관수축제(cathecolamine vasopressor)에 대한 반응이 적거나 거의 없기 때문에 개심술후 높은 이환율 및 사망율을 나타내는 상태를 말한다. 저자들은 개심술후 혈관확장성 쇼크(vasodilatory shock)로 진단되는 3명의 환자들에서 저용량의 아르기닌 바소프레신(AVP)를 사용하여 성공적으로 치료하였기에 관련된 문헌 고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제46권6호
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• pp.402-412
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• 2013

Background: Moderate and severe hypothermia with cardiopulmonary bypass during aortic surgery can cause some complications such as endothelial cell dysfunction or coagulation disorders. This study found out the difference of vascular reactivity by phenylephrine in moderate and severe hypothermia. Methods: Preserved aortic endothelium by excised rat thoracic aorta was sectioned, and then down the temperature rapidly to $25^{\circ}C$ by 15 minutes at $38^{\circ}C$ and then the vascular tension was measured. The vascular tension was also measured in rewarming at $25^{\circ}C$ for temperatures up to $38^{\circ}C$. To investigate the mechanism of the changes in vascular tension on hypothermia, NG-nitro-L-arginine methyl esther (L-NAME) and indomethacin administered 30 minutes before the phenylephrine administration. And to find out the hypothermic effect can persist after rewarming, endothelium intact vessel and endothelium denuded vessel exposed to hypothermia. The bradykinin dose-response curve was obtained for ascertainment whether endothelium-dependent hyperpolarization factor involves decreasing the phenylnephrine vascular reactivity on hypothermia. Results: Fifteen minutes of the moderate hypothermia blocked the maximum contractile response of phenylephrine about 95%. The vasorelaxation induced by hypothermia was significantly reduced with L-NAME and indomethacin administration together. There was a significant decreasing in phenylephrine susceptibility and maximum contractility after 2 hours rewarming from moderate and severe hypothermia in the endothelium intact vessel compared with contrast group. Conclusion: The vasoplegic syndrome after cardiac surgery might be caused by hypothermia when considering the vascular reactivity to phenylephrine was decreased in the endothelium-dependent mechanism.