Kahramanmaras Sutcu Imam University Medical Faculty, Department of Anesthesiology and Reanimation, Kahramanmaras, Turkey.
Kahramanmaras Sutcu Imam University Medical Faculty, Department of Biochemistry, Kahramanmaras, Turkey.
Braz J Anesthesiol. 2022 Jan-Feb;72(1):69-76. doi: 10.1016/j.bjane.2021.06.024. Epub 2021 Jul 16.
Cardiopulmonary bypass (CPB) causes systemic oxidative stress response and endothelial damage in systemic organs. We investigated the effects of positive end-expiratory pressure (PEEP) and mechanical ventilation (MV) applications on oxidative stress in CPB.
Seventy-one patients were recruited and 60 completed the study. Randomized groups: MV off (Group 1); MV on, tidal volume (TV) at 3-4 mL.kg (Group 2); MV on, TV at 3-4 mL.kg, PEEP at 5 cmH2O (Group 3), n = 20 in each group. As oxidative stress markers, we used glutathione peroxidase (GPx), total antioxidant status (TAS), total oxidant status (TOS), total and native thiol (TT, NT), malondialdehyde (MDA), and catalase. We also investigated the correlation between oxidative stress and postoperative intubation time.
The postoperative GPx levels in Group 2 were higher than Group 3 (p = 0.017). In groups 2 and 3, TAS levels were higher postoperatively than intraoperatively (p = 0.001, p = 0.019, respectively). In Group 2, the TT levels were higher postoperatively than preoperatively and intraoperatively (p = 0.008). In Group 3, the postoperative MDA levels were higher than preoperatively (p = 0.001) and were higher than both postoperative levels of Group 1 and 2 (p = 0.043, p = 0.003). As the preoperative TAS (Group 2) decreased and the postoperative NT (Group 2) and catalase (Group 3) increased, the postoperative intubation time lengthened.
MV ( 3-4 mL.kg) alone seems to be the most advantageous strategy. Prolonged postoperative intubation time was associated with both increased NT and catalase levels.
体外循环（CPB）会导致全身器官的系统性氧化应激反应和内皮损伤。我们研究了呼气末正压通气（PEEP）和机械通气（MV）应用对 CPB 中氧化应激的影响。
招募了 71 名患者，其中 60 名完成了研究。随机分组：MV 关闭（第 1 组）；MV 开启，潮气量（TV）为 3-4ml/kg（第 2 组）；MV 开启，TV 为 3-4ml/kg，PEEP 为 5cmH2O（第 3 组），每组 20 例。作为氧化应激标志物，我们使用谷胱甘肽过氧化物酶（GPx）、总抗氧化状态（TAS）、总氧化状态（TOS）、总巯基（TT）和天然巯基（NT）、丙二醛（MDA）和过氧化氢酶。我们还研究了氧化应激与术后插管时间之间的相关性。
第 2 组术后 GPx 水平高于第 3 组（p=0.017）。第 2 组和第 3 组术后 TAS 水平高于术中（p=0.001，p=0.019）。第 2 组术后 TT 水平高于术前和术中（p=0.008）。第 3 组术后 MDA 水平高于术前（p=0.001），且高于第 1 组和第 2 组术后的水平（p=0.043，p=0.003）。第 2 组术前 TAS（第 2 组）降低，术后 NT（第 2 组）和过氧化氢酶（第 3 组）升高，术后插管时间延长。
MV（3-4ml/kg）单独似乎是最有利的策略。术后延长的插管时间与 NT 和过氧化氢酶水平的升高有关。
