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La hipotensión causada por la circulación extracorpórea: la serotonina de las plaquetas activadas por la bomba

Piet Borgdorff¹, Durk Fekkes, Geert Jan Tangelder

¹Laboratory for Physiology, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands. p.borgdorff.physiol@med.vu.nl

|November 13, 2002

Resumen

La activación plaquetaria inducida por la bomba causa hipotensión durante el bypass cardiopulmonar y la hemodiálisis al liberar serotonina, que desencadena la liberación de óxido nítrico y la vasodilatación.

Área de la Ciencia:

Fisiología cardiovascular fisiología cardiovascular.
La hemodinámica es la hemodinámica.
Biología plaquetaria Biología plaquetaria.

Sus antecedentes:

Se sabe que el bypass cardiopulmonar y la hemodiálisis causan hipotensión.
Los mecanismos subyacentes, en particular los efectos inducidos por la bomba, requieren una mayor investigación.

Objetivo del estudio:

Investigar el papel de la activación plaquetaria inducida por la bomba y la liberación de serotonina en la causa de la hipotensión durante la circulación extracorpórea.
Para dilucidar las vías de señalización involucradas en los cambios hemodinámicos inducidos por la bomba.

Principales métodos:

Las derivaciones extracorporales se establecieron en ratas para la perfusión de la bomba y la autoperfusión.
Se monitorearon los parámetros hemodinámicos (presión aórtica, resistencia femoral) y los niveles plasmáticos de serotonina.
Se evaluaron los efectos de la agregación plaquetaria, la serotonina, el bloqueo del receptor de 5-hidroxitriptamina (5-HT) 2 y la inhibición del óxido nítrico (NO).

Principales resultados:

La perfusión con bomba, a diferencia de la autoperfusión, indujo una agregación plaquetaria significativa y una rápida caída de la presión aórtica.
La hipotensión y la resistencia femoral alterada se correlacionan con el aumento de los niveles plasmáticos de serotonina aguas abajo de la bomba.
El bloqueo de los receptores 5-HT2 o la inhibición de la producción de NO atenuaron o evitaron los cambios hemodinámicos observados.

Conclusiones:

La perfusión de la bomba con retorno arterial desencadena la activación de las plaquetas y la liberación de serotonina.
La serotonina media la hipotensión a través de la liberación endotelial de óxido nítrico (NO), activado a través de los receptores 5-HT2.
Estos hallazgos ponen de relieve un mecanismo que contribuye a la hipotensión durante los procedimientos extracorporales.

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