Grishin A V, Yavorovskiy A G, Charchian E R, Fedulova S V, Chamaia M A
Anesteziol Reanimatol. 2016 Sep;61(5):348-352.
Optimization of myocardial protection during cardiac surgery with a long period of anoxia infarction using sevoflurane postconditioning of myocardium.
to develop the optimal pharmacological postconditioning protocol with sevoflurane for infarction patients ,undergoing cardiac surgery.
Two groups were formedfor this study: CON] 00 (n-32) with aortic cross-clamping time 114±15 min and SEV100 group (n-34), where the myocardium anoxia was 119±22 minutes. According to previously developed in the pilot study Protocol, we added sevofturane in the circuit of extracorporeal circulation in a dose of 2.0 vol. % 20 minutes before removing the clamp from the aorta and the first 20 min of reperfusion in the group SE V100. In the group CON1 00 pharnacological postconditioning wasn't conducted. To assess the adequacy of the cardioprotection against ischemic damage in operated patients, we used the following clinical and laboratory parameters: changing the level of troponin T; the concentration of lactate and glucose as a marker of severity of anaerobic metabolism; concentration of proinflammatory cytokines IL-6, IL-8, TNF-alpha in blood serum as reperfusion injury markers. Also we used the registration of central hemodynamics data: measuring the mean invasive blood pressure; central venous pressure; Cardiac output was measured by the method of transesophageal echocardiography TEEcho-CG, calculated left ventricular ejection fraction by Simpson. We evaluated the clinical course of the perioperative period: incidence ofperioperative myocardial ischemia; the need and the duration ofuse of cardiotonic drugs in the perioperative period; the incidence of reperfusion arrhythmias; the frequency of self-recovery heart rate.
According to the results of anaerobic metabolism markers, we can conclude that the period of the myocardium anoxia ofpatients in both groups experienced no significant difference. However; a completely different pattern was observed when comparing the proinflammatory cytokines, such as IL-6, IL-8, TNF-a. This confirms that the group SEV] 00 survived the reperfusion is much better than the group CON100. Instrumental examination also showed that the group ofpatients in which pharmacological postconditioning with sevofturane was held signficantly better suffered ischemia and reperfiision injury compared to control group. Self-recovery heart rate after removing the aorta clamp in the group CON100 was observed in 81%, in group SEV100 same - 93%. Similarly, the frequency of myocardial ischemia episodes on the ECG in reperfusion period was two times lower in the group SEV100 compared with group CON100 - 5.8% and 12.5% respectively. Reperfusion arrhythmia is almost 3 times more frequent in the group CON100 - 21,8%, in the group SEV100, where he conducted pharmacological postconditioning with sevoflurane is 8.8%..
Combined with sevoflurane cardioprotection FPC has a much better resistance to myocardial ischemia-reperfusion injury in patients with myocardial infarction time over 100 minutes than monoprotection with cardioplegic solution "Console ". This method can be recommended as an additional method ofprotection against myocardial ischemia-reperfusion injury.
在长时间缺氧梗死的心脏手术中，通过七氟醚心肌后处理优化心肌保护。
为接受心脏手术的梗死患者制定使用七氟醚的最佳药理学后处理方案。
本研究分为两组：对照组（CON100，n = 32），主动脉交叉阻断时间为114±15分钟；七氟醚100组（SEV100，n = 34），心肌缺氧时间为119±22分钟。根据前期预试验制定的方案，在SEV100组中，于主动脉阻断钳松开前20分钟及再灌注的前20分钟，在体外循环回路中加入2.0体积%的七氟醚。CON100组未进行药理学后处理。为评估手术患者心肌缺血损伤的心脏保护效果，我们采用了以下临床和实验室参数：肌钙蛋白T水平变化；乳酸和葡萄糖浓度作为无氧代谢严重程度的标志物；血清中促炎细胞因子IL - 6、IL - 8、TNF -α的浓度作为再灌注损伤标志物。我们还记录了中心血流动力学数据：测量有创平均血压；中心静脉压；通过经食管超声心动图（TEEcho - CG）测量心输出量，用Simpson法计算左心室射血分数。我们评估了围手术期的临床过程：围手术期心肌缺血的发生率；围手术期强心药物的使用需求及持续时间；再灌注心律失常的发生率；自主恢复心率的频率。
根据无氧代谢标志物的结果，我们可以得出两组患者的心肌缺氧时间无显著差异。然而，在比较促炎细胞因子如IL - 6、IL - 8、TNF -α时，观察到了完全不同的模式。这证实SEV100组在再灌注时的情况比CON100组好得多。器械检查还表明，与对照组相比，接受七氟醚药理学后处理的患者组在缺血和再灌注损伤方面的情况明显更好。CON100组在松开主动脉阻断钳后，81%的患者出现自主恢复心率，SEV100组为93%。同样，在再灌注期，SEV100组心电图上心肌缺血发作的频率比CON100组低两倍，分别为5.8%和12.5%。CON100组再灌注心律失常的发生率几乎是SEV100组的3倍，分别为21.8%和8.8%，SEV100组进行了七氟醚药理学后处理。
与七氟醚心脏保护相结合的FPC在心肌梗死时间超过100分钟的患者中，对心肌缺血 - 再灌注损伤的抵抗能力比单纯使用心脏停搏液“Console”保护要好得多。该方法可作为预防心肌缺血 - 再灌注损伤的一种补充方法推荐使用。
