Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
Department of Anesthesiology, Guangdong General Hospital, Guangzhou, Guangdong, China.
Heart Surg Forum. 2021 Oct 21;24(5):E916-E924. doi: 10.1532/hsf.4139.
Two consistent overall cell protective preconditioning treatments should provide more protection. We hypothesized that limb remote ischemic preconditioning (RIPC, second preconditioning stimulus) applied during sevoflurane inhalation (first preconditioning stimulus) would provide more protection to the lungs of patients undergoing adult heart valve surgery.
In this randomized, placebo-controlled, double-blind trial, 50 patients were assigned to the RIPC group or the placebo group (1:1). Patients in the RIPC group received three 5-min cycles of 300 mmHg cuff inflation/deflation of the left-side lower limb before aortic cross-clamping. Anesthesia consisted of opioids and propofol for induction and sevoflurane for maintenance. The primary end point was comparison of the postoperative arterial-alveolar oxygen tension ratio (a/A ratio) between groups. Secondary end points included comparisons of pulmonary variables, postoperative morbidity and mortality and regional and systemic inflammatory cytokines between groups.
In the RIPC group, the a/A ratio and other pulmonary variables exhibited no significant differences throughout the study period compared with the placebo group. No significant differences in either plasma or bronchoalveolar lavage levels of TNF- α were noted between the groups at 10 min after anesthetic induction and 1 h after cross-clamp release. The percentage of neutrophils at 12 h postoperation was significantly increased in the RIPC group compared with the placebo group (91.34±0.00 vs. 89.42±0.10, P = 0.023).
Limb RIPC applied during sevoflurane anesthesia did not provide additional significant pulmonary protection following adult valvular cardiac surgery.
两种一致的整体细胞保护预处理应该提供更多的保护。我们假设，在七氟醚吸入（第一预处理刺激）期间应用肢体远程缺血预处理（RIPC，第二预处理刺激）将为接受成人心脏瓣膜手术的患者的肺部提供更多的保护。
在这项随机、安慰剂对照、双盲试验中，将 50 名患者分配到 RIPC 组或安慰剂组（1:1）。RIPC 组的患者在主动脉夹闭前接受三次 5 分钟的左下肢 300mmHg 袖带充气/放气循环。麻醉由阿片类药物和异丙酚诱导，七氟醚维持。主要终点是比较两组术后动脉-肺泡氧分压比（a/A 比）。次要终点包括比较两组间的肺变量、术后发病率和死亡率以及局部和全身炎症细胞因子。
与安慰剂组相比，RIPC 组在整个研究期间的 a/A 比和其他肺变量均无显著差异。麻醉诱导后 10 分钟和夹闭释放后 1 小时，两组血浆或支气管肺泡灌洗液中 TNF-α的水平均无显著差异。与安慰剂组相比，RIPC 组术后 12 小时的中性粒细胞百分比显著增加（91.34±0.00 与 89.42±0.10，P=0.023）。
在七氟醚麻醉期间应用肢体 RIPC 不能为成人心脏瓣膜手术后提供额外的显著的肺保护。
