Sedighinejad Abbas, Imantalab Vali, Mirmansouri Ali, Naderi Nabi Bahram, Tarbiat Masoud, Sadeghi Ali Mohammad, Nassiri Sheikhani Nassir, Haghighi Mohammad, Sayahe Varag Zahra
Associate Professor of Anesthesiology, Fellowship of Anesthesia in Cardiac Surgery, Anesthesiology Research Center, Guilan University of Medical Sciences (GUMS), Rasht, Iran.
MD, Associate Professor of Anesthesiology, Fellowship of Anesthesia and Pain (FIPP), Anesthesiology Department, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran.
Anesth Pain Med. 2016 Nov 21;6(6):e42066. doi: 10.5812/aapm.42066. eCollection 2016 Dec.
Major surgeries such as open-heart surgery with cardiopulmonary bypass are associated with a complexity of stress response leading to post-operative complications. Studies have confirmed that anesthesia can mitigate the surgically induced stress response.
The aim of this study was to compare the effects of propofol and isoflurane, both supplemented with Sufentanil, on the stress response in coronary artery bypass graft surgery with cardiopulmonary bypass, using cortisol as a biochemical marker.
This double-blind randomized clinical trial was conducted on 72 patients who underwent coronary artery bypass grafting (CABG) with cardiopulmonary bypass meeting the inclusion criteria. The subjects were randomly divided into two groups of isoflurane (n = 36) and propofol (n = 36) both supplemented with sufentanil. Serum cortisol levels were measured and compared between the groups; 30 minutes before the surgery (T0), at the end of the cardiopulmonary bypass (T1), and 24 hours after the surgery (T2).
Compared to the baseline (T0), at the end of cardiopulmonary bypass (T1), both groups demonstrated a decrease in plasma cortisol levels with no statistical significant difference (P = 0.4). At T2 measuring time point, the level of plasma cortisol significantly increased in both groups (P = 0.02), however this increase was less in the Isoflurane group.
In CABG with cardiopulmonary bypass, using plasma cortisol level as a measure, Isoflurane-Sufentanil significantly reduces the stress response to the surgery, when compared to propofol-Sufentanil.
诸如体外循环心脏直视手术等大型手术会引发复杂的应激反应，进而导致术后并发症。研究证实，麻醉可减轻手术引起的应激反应。
本研究旨在比较丙泊酚和异氟烷（均辅以舒芬太尼）对体外循环冠状动脉搭桥手术应激反应的影响，以皮质醇作为生化指标。
本双盲随机临床试验纳入了72例符合纳入标准且接受体外循环冠状动脉搭桥术（CABG）的患者。受试者被随机分为两组，异氟烷组（n = 36）和丙泊酚组（n = 36），两组均辅以舒芬太尼。测量并比较两组在手术前30分钟（T0）、体外循环结束时（T1）和手术后24小时（T2）的血清皮质醇水平。
与基线（T0）相比，体外循环结束时（T1），两组血浆皮质醇水平均下降，差异无统计学意义（P = 0.4）。在T2测量时间点，两组血浆皮质醇水平均显著升高（P = 0.02），然而异氟烷组的升高幅度较小。
在体外循环冠状动脉搭桥手术中，以血浆皮质醇水平作为衡量指标，与丙泊酚-舒芬太尼相比，异氟烷-舒芬太尼能显著降低手术应激反应。
