Department of Anaesthesiology and Intensive Care, Université Caen-Normandie, Centre Hospitalier Universitaire de Caen, 14033 Caen, France.
Department of Anaesthesiology and Intensive Care, Université Caen-Normandie, Centre Hospitalier Universitaire de Caen, 14033 Caen, France.
Anaesth Crit Care Pain Med. 2018 Jun;37(3):217-223. doi: 10.1016/j.accpm.2017.05.009. Epub 2017 Sep 21.
Myocardial ischaemia reperfusion injury following cardiac surgery with cardiopulmonary bypass (CPB) increases postoperative mortality. Setting techniques to protect the heart during this critical period therefore represents a considerable challenge.
A randomised controlled study in Caen University Hospital Centre, investigated whether the clinical cardio protective effects of administration sevoflurane before cardiopulmonary bypass during coronary artery bypass graft surgery (CABG) could translate into protected atrial trabeculae contractility against hypoxia-reoxygenation in vitro. Patients undergoing elective on-pump CABG surgery were allocated to receive either sevoflurane (n=24) or no halogenated volatile anaesthetic (n=21).
the relationship between sevoflurane exposure before CPB and the incidence of major adverse cardiac events, with primary endpoint: the postoperative troponin I peak level, and secondary endpoints: the inotropic support, and the duration of stay in intensive unit and in-hospital stay were chosen as study endpoints. The right atrial was collected at the beginning of bypass surgery for the in vitro experimentation. Isometrically contracting isolated human right atrial trabeculae obtained from the two groups were exposed to 30-min hypoxia followed by 60-min reoxygenation.
The patients receiving sevoflurane prior to aortic clamping significantly exhibited less cardiac Troponin I (1.39 [0.34-2.97] vs. 2.80 [2.54-3.64] ng·mL in Control; P=0.03) and required a reduced inotropic drug support (P<0.001). Isolated trabeculae from patients receiving sevoflurane enhanced the recovery of force after reoxygenation compared to the Control group (79±5% vs. 53±8% of baseline in Control; P<0.001).
Administration of sevoflurane before CPB induced cardioprotection in patients undergoing CABG and preconditioned human myocardium against hypoxia-reoxygenation in vitro.
体外循环（CPB）心脏手术后的心肌缺血再灌注损伤增加了术后死亡率。因此，在这一关键时期设置保护心脏的技术是一项相当大的挑战。
卡昂大学医院中心进行了一项随机对照研究，研究了在体外冠状动脉旁路移植术（CABG）中 CPB 前给予七氟醚对心脏的临床保护作用是否能转化为对缺氧-复氧时心房小梁收缩性的保护。择期体外循环 CABG 手术患者被分配接受七氟醚（n=24）或无卤代挥发性麻醉剂（n=21）。
CPB 前七氟醚暴露与主要不良心脏事件发生率之间的关系，主要终点：术后肌钙蛋白 I 峰值水平，次要终点：正性肌力支持和重症监护病房停留时间和住院时间。在 CPB 手术开始时收集右心房，用于体外实验。从两组中获得的等长收缩的分离的人右心房小梁在 30 分钟缺氧后暴露于 60 分钟复氧。
在主动脉夹闭前接受七氟醚的患者心脏肌钙蛋白 I 显著减少（1.39[0.34-2.97]与对照组 2.80[2.54-3.64]ng·mL；P=0.03），需要减少正性肌力药物支持（P<0.001）。与对照组相比，接受七氟醚的患者的分离小梁在复氧后恢复力增强（79±5%与对照组 53±8%基线；P<0.001）。
CPB 前给予七氟醚可诱导 CABG 患者的心脏保护作用，并使体外人心肌对缺氧-复氧产生预处理作用。
