Bignami Elena, Guarnieri Marcello, Pieri Marina, De Simone Francesco, Rodriguez Alcira, Cassarà Luigi, Lembo Rosalba, Landoni Giovanni, Zangrillo Alberto
1 Anaesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
2 Cardiothoracic Surgery Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Perfusion. 2017 Oct;32(7):547-553. doi: 10.1177/0267659117701562. Epub 2017 Apr 11.
Every year, over 1 million cardiac surgical procedures are performed all over the world. Reducing myocardial necrosis could have strong implications in postoperative clinical outcomes. Volatile anaesthetics have cardiac protective properties in the perioperative period of cardiac surgery. However, little data exists on the administration of volatile agents during cardiopulmonary bypass. The aim of this study was to assess if volatile anaesthetics administration during cardiopulmonary bypass reduces cardiac troponin release after cardiac surgery.
We retrospectively analysed data from 942 patients who underwent cardiac surgery in a teaching hospital. The only difference between the groups was the management of anaesthesia during CPB. The volatile group received sevoflurane or desflurane while the control group received a combination of propofol infusion and fentanyl boluses. Patients who received volatile anaesthetics during cardiopulmonary bypass (n=314) were propensity-matched 1:2 with patients who did not receive volatile anaesthetics during CPB (n=628).
We found a reduction in peak postoperative troponin I, from 7.8 ng/ml (4.8-13.1) in the non-volatile group to 6.8 ng/ml (3.7-11.8) in the volatile group (p=0.013), with no differences in mortality [2 (0.6%) in the volatile group and 2 (0.3%) in the non-volatile group (p=0.6)].
Adding volatile anaesthetics during cardiopulmonary bypass was associated with reduced peak postoperative troponin levels. Larger studies are required to confirm our data and to assess the effect of volatile agents on survival.
全球每年进行超过100万例心脏外科手术。减少心肌坏死对术后临床结果可能有重大影响。挥发性麻醉剂在心脏手术围术期具有心脏保护作用。然而，关于体外循环期间使用挥发性麻醉剂的数据很少。本研究的目的是评估体外循环期间使用挥发性麻醉剂是否能减少心脏手术后心肌肌钙蛋白的释放。
我们回顾性分析了一家教学医院942例行心脏手术患者的数据。两组之间唯一的差异是体外循环期间的麻醉管理。挥发性麻醉剂组接受七氟醚或地氟醚，而对照组接受丙泊酚输注和芬太尼推注联合使用。在体外循环期间接受挥发性麻醉剂的患者（n = 314）与未接受挥发性麻醉剂的患者（n = 628）按1:2进行倾向匹配。
我们发现术后肌钙蛋白I峰值有所降低，非挥发性麻醉剂组从7.8 ng/ml（4.8 - 13.1）降至挥发性麻醉剂组的6.8 ng/ml（3.7 - 11.8）（p = 0.013），死亡率无差异[挥发性麻醉剂组为2例（0.6%），非挥发性麻醉剂组为2例（0.3%）（p = 0.6）]。
体外循环期间添加挥发性麻醉剂与术后肌钙蛋白峰值水平降低有关。需要更大规模的研究来证实我们的数据，并评估挥发性麻醉剂对生存率的影响。
