择期住院腹部手术中心脏保护的远程缺血预处理——一项随机对照试验
Remote ischemic preconditioning for cardioprotection in elective inpatient abdominal surgery - a randomized controlled trial.
作者信息
Antonowicz Stefan Samad, Cavallaro Davina, Jacques Nicola, Brown Abby, Wiggins Tom, Haddow James B, Kapila Atul, Coull Dominic, Walden Andrew
机构信息
Department of Surgery, Royal Berkshire NHS Foundation Trust, Reading, UK.
London Surgical Research Group, Reading, UK.
出版信息
BMC Anesthesiol. 2018 Jun 26;18(1):76. doi: 10.1186/s12871-018-0524-6.
BACKGROUND
Perioperative myocardial injury (PMI) is common in elective inpatient abdominal surgery and correlates with mortality risk. Simple measures for reducing PMI in this cohort are needed. This study evaluated whether remote ischemic preconditioning (RIPC) could reduce PMI in elective inpatient abdominal surgery.
METHODS
This was a double-blind, sham-controlled trial with 1:1 parallel randomization. PMI was defined as any post-operative serum troponin T (hs-TNT) > 14 ng/L. Eighty-four participants were randomized to receiving RIPC (5 min of upper arm ischemia followed by 5 min reperfusion, for three cycles) or a sham-treatment immediately prior to surgery. The primary outcome was mean peak post-operative troponin in patients with PMI, and secondary outcomes included mean hs-TnT at individual timepoints, post-operative hs-TnT area under the curve (AUC), cardiovascular events and mortality. Predictors of PMI were also collected. Follow up was to 1 year.
RESULTS
PMI was observed in 21% of participants. RIPC did not significantly influence the mean peak post-operative hs-TnT concentration in these patients (RIPC 25.65 ng/L [SD 9.33], sham-RIPC 23.91 [SD 13.2], mean difference 1.73 ng/L, 95% confidence interval - 9.7 to 13.1 ng/L, P = 0.753). The treatment did not influence any secondary outcome with the pre-determined definition of PMI. Redefining PMI as > 5 ng/L in line with recent data revealed a non-significant lower incidence in the RIPC cohort (68% vs 81%, P = 0.211), and significantly lower early hs-TnT release (12 h time-point, RIPC 5.5 ng/L [SD 5.5] vs sham 9.1 ng/L [SD 8.2], P = 0.03).
CONCLUSIONS
RIPC did not at reduce the incidence or severity of PMI in these general surgical patients using pre-determined definitions. PMI is nonetheless common and effective cardioprotective strategies are required.
TRIAL REGISTRATION
This trial was registered with Clinicaltrials.gov, NCT01850927 , 5th July 2013.
背景
围手术期心肌损伤（PMI）在择期住院腹部手术中很常见，且与死亡风险相关。需要采取简单措施来降低该队列中的PMI。本研究评估了远程缺血预处理（RIPC）能否降低择期住院腹部手术中的PMI。
方法
这是一项双盲、假手术对照试验，采用1:1平行随机分组。PMI定义为术后任何时间血清肌钙蛋白T（hs-TNT）>14 ng/L。84名参与者被随机分为在手术前接受RIPC（上臂缺血5分钟，随后再灌注5分钟，共三个周期）或假治疗。主要结局是发生PMI患者术后肌钙蛋白的平均峰值，次要结局包括各个时间点的平均hs-TnT、术后hs-TnT曲线下面积（AUC）、心血管事件和死亡率。还收集了PMI的预测因素。随访至1年。
结果
21%的参与者出现PMI。RIPC对这些患者术后hs-TnT的平均峰值浓度没有显著影响（RIPC为25.65 ng/L[标准差9.33]，假RIPC为23.91[标准差13.2]，平均差异为1.73 ng/L，95%置信区间为-9.7至13.1 ng/L，P = 0.753）。该治疗对预先定义的PMI的任何次要结局均无影响。根据近期数据将PMI重新定义为>5 ng/L后，RIPC队列中的发病率较低但无统计学意义（68%对81%，P = 0.211），且早期hs-TnT释放显著降低（12小时时间点，RIPC为5.5 ng/L[标准差5.5]，假手术为9.1 ng/L[标准差8.2]，P = 0.03）。
结论
使用预先定义的标准，RIPC并未降低这些普通外科患者PMI的发生率或严重程度。尽管如此，PMI仍然很常见，需要有效的心脏保护策略。
试验注册
本试验已在Clinicaltrials.gov注册，NCT01850927，2013年7月5日。
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