地氟烷和丙泊酚方案对预处理的影响。

The effect of desflurane and propofol protocols on preconditioning.

作者信息

Onk Didem, Ozcelik Fatih, Kuyrukluyıldız Ufuk, Gunay Murat, Onk Alper, Ayazoglu Tulin Akarsu, Coban Abdulkadir, Alagol Aysin

机构信息

Anesthesiology Department, Erzincan University, Erzincan, Turkey.

Clinical Biochemistry Laboratory, Erzincan Military Hospital, Erzincan, Turkey.

出版信息

Adv Clin Exp Med. 2017 Aug;26(5):817-823. doi: 10.17219/acem/61045.

DOI:10.17219/acem/61045

PMID:29068578

Abstract

BACKGROUND

Preconditioning is one of the most powerful mechanisms preventing the myocardial ischemic damage that occurs during coronary artery bypass grafting.

OBJECTIVES

We aimed to investigate the effects of different propofol and/or desflurane administration protocols in terms of the prevention of ischaemia-reperfusion damage.

MATERIAL AND METHODS

Ninety patients, aged > 18 years, American Society of Anesthesiologists (ASA) category III, scheduled to undergo primary elective coronary artery bypass grafting (CABG), were included in the study. During maintenance, the patients in group 1 (n = 30) received a propofol infusion (5-6 mg/kg/h) combined with a fentanyl infusion (3-5 mcg/kg/h); the patients in group 2 (n = 30) also received a propofol infusion (5-6 mg/kg/h) combined with a fentanyl infusion (3-5 mcg/kg/h), but they were also given 6% desflurane inhalation for 15 min both before cross-clamping of the aorta and after removal of the clamp; the patients in group 3 (n = 30) received a propofol infusion (2-3 mg/kg/h) combined with a fentanyl infusion (3-5 mcg/kg/h) and received the continuous 6% desflurane inhalation. Blood samples were drawn in the preoperative period (S1), during cardiopulmonary bypass, before cross-clamping the aorta (S2), after removal of the cross-clamp (S3) and 24 h after the operation (S4).

RESULTS

All groups were similar in terms of age and BMI (p > 0.05). TNF-α levels were higher at S3 compared to S1, S2 and S4 (p > 0.001). The TNF-α levels at S4 were lower in group 3 than those in group 1 and group 2 (p < 0.05). In all groups, h-FABP levels showed an increase in S3 but were significantly lower at S4 (p < 0.05). In group 3, h-FABP levels at S2 and S3 were significantly lower than those in group 1 (p < 0.05). There was a moderate correlation between h-FABP and TNF-α levels (Spearman's rho = 0.472, p < 0.001).

CONCLUSIONS

On the basis of the measurement of h-FABP and TNF-α, low-dose propofol and continuous desflurane inhalation provide more effective preconditioning than propofol alone or a short course of desflurane in patients undergoing CABG.

摘要

背景

预处理是预防冠状动脉搭桥术中发生心肌缺血损伤的最有效机制之一。

目的

我们旨在研究不同的丙泊酚和/或地氟醚给药方案对预防缺血再灌注损伤的效果。

材料与方法

本研究纳入了90例年龄>18岁、美国麻醉医师协会（ASA）分级为III级、计划接受初次择期冠状动脉搭桥术（CABG）的患者。在维持麻醉期间，第1组（n = 30）患者接受丙泊酚输注（5 - 6 mg/kg/h）联合芬太尼输注（3 - 5 mcg/kg/h）；第2组（n = 30）患者同样接受丙泊酚输注（5 - 6 mg/kg/h）联合芬太尼输注（3 - 5 mcg/kg/h），但在主动脉交叉阻断前和阻断钳移除后还给予6%地氟醚吸入15分钟；第3组（n = 30）患者接受丙泊酚输注（2 - 3 mg/kg/h）联合芬太尼输注（3 - 5 mcg/kg/h）并持续吸入6%地氟醚。在术前阶段（S1）、体外循环期间、主动脉交叉阻断前（S2）、交叉阻断钳移除后（S3）以及术后24小时（S4）采集血样。

结果

所有组在年龄和体重指数方面相似（p > 0.05）。与S1、S2和S4相比，S3时肿瘤坏死因子-α（TNF-α）水平更高（p > 0.001）。第3组S4时的TNF-α水平低于第1组和第2组（p < 0.05）。在所有组中，人脂肪酸结合蛋白（h-FABP）水平在S3时升高，但在S4时显著降低（p < 0.05）。第3组S2和S3时的h-FABP水平显著低于第1组（p < 0.05）。h-FABP与TNF-α水平之间存在中度相关性（Spearman相关系数 = 0.472，p < 0.001）。