Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Universitätsklinikum Essen, Germany.
Acta Anaesthesiol Scand. 2012 Jan;56(1):30-8. doi: 10.1111/j.1399-6576.2011.02585.x. Epub 2011 Nov 21.
Remote ischemic preconditioning (RIPC) of the myocardium by limb ischemia/reperfusion may mitigate cardiac damage, but its interaction with the anesthetic regimen is unknown. We tested whether RIPC is associated with differential effects depending on background anesthesia. Specifically, we hypothesized that RIPC during isoflurane anesthesia attenuates myocardial injury in patients undergoing coronary artery bypass graft (CABG) surgery, and that effects may be different during propofol anesthesia.
In a randomized, single-blinded, placebo-controlled prospective study, serum troponin I concentration (cTnI) (baseline, and 1, 6, 12, 24, 48, and 72 h postoperatively) were measured during isoflurane/sufentanil or propofol/sufentanil anesthesia with or without RIPC (three 5-min periods of intermittent left upper arm ischemia with 5 min reperfusion each) in non-diabetic patients (n = 72) with three-vessel coronary artery disease (ClinicalTrials.gov NCT01406678).
RIPC during isoflurane anesthesia (n = 20) decreased the area under the cTnI time curve (cTnI AUC) (-50%, 190 ± 105 ng/ml × 72 h vs. 383 ± 262 ng/ml × 72 h, P = 0.004), and the peak (7.3 ± 3.6 ng/ml vs. 11.8 ± 5.5, P = 0.004) and serial (P < 0.041) postoperative cTnI when compared to isoflurane alone (n = 19). In contrast, RIPC during propofol anesthesia (n = 14) did not alter the cTnI AUC [263 ± 157 ng/ml × 72 h vs. 372 ± 376 ng/ml × 72 h (n = 19), P = 0.318] or peak postoperative cTnI (10.1 ± 4.5 ng/ml vs. 12 ± 8.2, P = 0.444). None of the patients experienced harm or side effects from the intermittent left arm ischemia.
Thus, RIPC during isoflurane but not during propofol anesthesia decreased myocardial damage in patients undergoing CABG surgery. Accordingly, effects of RIPC evoked by upper limb ischemia/reperfusion depend on background anesthesia, with combined RIPC/isoflurane exerting greater beneficial effects under conditions studied.
肢体缺血/再灌注的远程缺血预处理（RIPC）可能减轻心肌损伤，但它与麻醉方案的相互作用尚不清楚。我们测试了 RIPC 是否与背景麻醉的不同效果相关。具体来说，我们假设异氟烷麻醉期间的 RIPC 会减轻接受冠状动脉旁路移植术（CABG）手术患者的心肌损伤，而丙泊酚麻醉期间的效果可能不同。
在一项随机、单盲、安慰剂对照的前瞻性研究中，在非糖尿病患者（n = 72）中，在接受三血管冠状动脉疾病（ClinicalTrials.gov NCT01406678）治疗的情况下，使用异氟烷/舒芬太尼或丙泊酚/舒芬太尼麻醉，并在没有或有 RIPC（三个 5 分钟的左上肢间歇性缺血期，每个缺血期有 5 分钟的再灌注期）时，测量血清肌钙蛋白 I 浓度（cTnI）（基线和术后 1、6、12、24、48 和 72 小时）。
异氟烷麻醉期间的 RIPC（n = 20）降低了 cTnI 时间曲线下面积（cTnI AUC）（-50%，190 ± 105 ng/ml × 72 h 与 383 ± 262 ng/ml × 72 h，P = 0.004），并且与单独使用异氟烷（n = 19）相比，cTnI 的峰值（7.3 ± 3.6 ng/ml 与 11.8 ± 5.5，P = 0.004）和连续（P < 0.041）术后 cTnI 均降低。相比之下，丙泊酚麻醉期间的 RIPC（n = 14）并未改变 cTnI AUC [263 ± 157 ng/ml × 72 h 与 372 ± 376 ng/ml × 72 h（n = 19），P = 0.318]或术后峰值 cTnI（10.1 ± 4.5 ng/ml 与 12 ± 8.2，P = 0.444）。没有患者因间歇性左上肢缺血而遭受伤害或出现副作用。
因此，异氟烷麻醉期间的 RIPC 而不是丙泊酚麻醉期间的 RIPC 降低了接受 CABG 手术患者的心肌损伤。因此，由上肢缺血/再灌注引起的 RIPC 的效果取决于背景麻醉，在研究条件下，联合 RIPC/异氟烷可产生更大的有益效果。
