Amr Yasser Mohamed, Yassin Ibrahim M
Tanta University, Egypt.
Semin Cardiothorac Vasc Anesth. 2010 Sep;14(3):205-11. doi: 10.1177/1089253210376839. Epub 2010 Jul 23.
To compare the cardioprotective effects of anesthetic preconditioning by isoflurane with ischemic preconditioning.
A total of 45 patients scheduled for elective coronary artery bypass graft (CABG) surgery were randomized to preconditioning either by 3 episodes of 1-minute aortic cross-clamping followed by 4 minutes of reperfusion after each episode, a 10-minute exposure to isoflurane 2.5% followed by 5 minutes of washout, or no preconditioning technique (control group). Hemodynamic data, cardiac troponin I (cTnI), creatine kinase isoenzyme MB (CK-MB) release, need for inotropic support, hospital stay, and adverse cardiac events were measured and recorded.
Preconditioned patients showed marked improvement in hemodynamic data, less need for inotropic support, and less postoperative increase in the serum levels of CK-MB and cTnI. No significant difference in hospital stay was found. Also, 4 patients in the control group had adverse cardiac events versus 1 patient in the isoflurane and ischemic groups in 1 year of follow-up.
Based on this very small sample size, these data support a cardioprotective effect of isoflurane and ischemic preconditioning during CABG surgery.
比较异氟烷麻醉预处理与缺血预处理的心脏保护作用。
总共45例计划行择期冠状动脉搭桥术（CABG）的患者被随机分为三组，分别接受以下预处理：每组进行3次1分钟的主动脉交叉阻断，每次阻断后再灌注4分钟；暴露于2.5%异氟烷10分钟，然后冲洗5分钟；不采用任何预处理技术（对照组）。测量并记录血流动力学数据、心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶MB（CK-MB）释放、是否需要使用正性肌力药物支持、住院时间以及不良心脏事件。
接受预处理的患者血流动力学数据显著改善，对正性肌力药物支持的需求减少，术后血清CK-MB和cTnI水平升高幅度较小。住院时间无显著差异。此外，在1年的随访中，对照组有4例患者发生不良心脏事件，而异氟烷组和缺血预处理组各有1例。
基于这个非常小的样本量，这些数据支持异氟烷和缺血预处理在CABG手术期间具有心脏保护作用。
