We retrospectively studied the influence of a decrease in hemoglobin(Hb)oxygen dissociation ability within the oxygen supply-demand balance of 25 patients without and 12 patients with diabetes mellitus(DM)who underwent open heart surgery under a normothermic cardiopulmonary bypass(CPB). Bound oxygen delivery(bound DO
2I), soluble oxygen delivery(soluble DO
2I), bound oxygen consumption(bound VO
2I), soluble oxygen consumption(soluble VO
2I), bound oxygen extraction ratio(bound O
2ER), soluble oxygen extraction ratio(soluble O
2ER)and the ratio of bound VO
2I to total VO
2I(%bound VO
2)were measured from cardiac output(CO), blood gas data, and perfusion indices obtained during CPB. The Hb oxygen saturation was determined as Hb oxygen fractional saturation(%O
2 Hb). The sum of bound DO
2 and soluble DO
2 was >300mL/min/m
2, the lactate value was <2.5mmol/L, and lactic acidosis was absent in both groups. Although HbA1
C was significantly higher in the DM than in the normal group, P50 did not significantly differ between the groups before CPB, indicating that P50 did not correlate with HbA1
C. On the other hand, P50 continued to decrease in the DM group after the start of CPB and significantly differed in the ICU. The Hb value did not significantly differ between the groups. However, bound O
2ER and %bound VO
2 were lower and %vO
2 Hb was higher in the DM than in the normal group during CPB. Bound O
2ER also decreased with increasing soluble DO
2I, and this decrease was greater in the DM group. These findings indicate that these differences were due to a decrease in the ability of Hb oxygen to dissociate. The decrease in P50 did not directly reflect the increase in HbA1
C, but it nevertheless suggests the presence of a complex compensatory mechanism. Although a sufficient amount of oxygen was supplied and the %vO
2 Hb remained at or above the reference value, our findings suggest that either oxygen intake was disrupted or oxygen was not utilized by tissues. In summary, dysoxia caused by the decreased ability of Hb oxygen dissociation in the DM group rendered evaluation of the oxygen supply-demand balance through monitoring only %vO
2 Hb and Pv-O
2 difficult. Furthermore, the decrease in Hb oxygen dissociation ability could be prevented by avoiding high soluble DO
2I(PaO
2).
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