Jin Mu, Yang Yanwei, Pan Xudong, Lu Jiakai, Zhang Zhiquan, Cheng Weiping
Department of Anaesthesiology Department of Cardiology Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China Department of Anesthesiology, Duke University Medical Center, Durham, NC.
Medicine (Baltimore). 2017 Mar;96(10):e6253. doi: 10.1097/MD.0000000000006253.
The goal of this study was to investigate the effects of pulmonary static inflation with 50% xenon on postoperative oxygen impairment during cardiopulmonary bypass (CPB) for Stanford type A acute aortic dissection (AAD).
This prospective single-center nonrandomized controlled clinical trial included 100 adult patients undergoing surgery for Stanford type A AAD at an academic hospital in China. Fifty subjects underwent pulmonary static inflation with 50% oxygen from January 2013 to January 2014, and 50 underwent inflation with 50% xenon from January 2014 to December 2014. During CPB, the lungs were inflated with either 50% xenon (xenon group) or 50% oxygen (control group) to maintain an airway pressure of 5 cm H2O. The primary outcome was oxygenation index (OI) value after intubation, and 10 minutes and 6 hours after the operation. The second outcome was cytokine and reactive oxygen species levels after intubation and 10 minutes, 6 hours, and 24 hours after the operation.
Patients treated with xenon had lower OI levels compared to the control group before surgery (P = 0.002); however, there was no difference in postoperative values between the 2 groups. Following surgery, mean maximal OI values decreased by 18.8% and 33.8%, respectively, in the xenon and control groups. After surgery, the levels of interleukin-6 (IL-6), tumor necrosis factor alpha, and thromboxane B2 decreased by 23.5%, 9.1%, and 30.2%, respectively, in the xenon group, but increased by 10.8%, 26.2%, and 26.4%, respectively, in the control group. Moreover, IL-10 levels increased by 28% in the xenon group and decreased by 7.5% in the control group. There were significant time and treatment-time interaction effects on methane dicarboxylic aldehyde (P = 0.000 and P = 0.050, respectively) and myeloperoxidase (P = 0.000 and P = 0.001 in xenon and control groups, respectively). There was no difference in hospital mortality and 1-year survival rate between the 2 groups.
Pulmonary static inflation with 50% xenon during CPB could attenuate OI decreases at the end of surgery for Stanford type A AAD. Thus, xenon may function by triggering anti-inflammatory responses and suppressing pro-inflammatory and oxidative effects.
本研究的目的是探讨在斯坦福A型急性主动脉夹层（AAD）的体外循环（CPB）期间，使用50%氙气进行肺静态充气对术后氧损伤的影响。
这项前瞻性单中心非随机对照临床试验纳入了100例在中国一家学术医院接受斯坦福A型AAD手术的成年患者。2013年1月至2014年1月，50名受试者用50%氧气进行肺静态充气，2014年1月至2014年12月，50名受试者用50%氙气进行充气。在CPB期间，肺用50%氙气（氙气组）或50%氧气（对照组）充气以维持气道压力5 cm H2O。主要结局是插管后、术后10分钟和6小时的氧合指数（OI）值。次要结局是插管后、术后10分钟、6小时和24小时的细胞因子和活性氧水平。
与对照组相比，氙气治疗的患者术前OI水平较低（P = 0.002）；然而，两组术后值无差异。术后，氙气组和对照组的平均最大OI值分别下降了18.8%和33.8%。术后，氙气组白细胞介素-6（IL-6）、肿瘤坏死因子α和血栓素B2水平分别下降了23.5%、9.1%和30.2%，而对照组分别上升了10.8%、26.2%和26.4%。此外，氙气组IL-10水平上升了28%，对照组下降了7.5%。对于丙二醛（分别为P = 0.000和P = 0.050）和髓过氧化物酶（氙气组和对照组分别为P = 0.000和P = 0.001），存在显著的时间和治疗-时间交互作用。两组的医院死亡率和1年生存率无差异。
CPB期间用50%氙气进行肺静态充气可减轻斯坦福A型AAD手术结束时OI的下降。因此，氙气可能通过触发抗炎反应和抑制促炎及氧化作用发挥作用。
