地氟醚和异丙酚预处理对心肌缺血再灌注损伤的影响
本公众号每天分享一篇最新一期Anesthesia & Analgesia等SCI杂志的摘要翻译，敬请关注并提出宝贵意见
The effect of desflurane and propofol protocols on preconditioning
背景与目的
预处理是预防冠状动脉旁路移植术中发生心肌缺血性损伤的最有效机制之一。我们的目的是研究不同浓度的异丙酚和/或地氟醚给药方案在预防心肌缺血再灌注损伤方面的影响。
方 法
本研究纳入了90例年龄> 18岁、ASA分级III级且预计接受选择性冠状动脉旁路移植术（CABG）的患者。 在麻醉维持期间，组1（n = 30）的患者接受异丙酚（5-6mg / kg / h）联合芬太尼（3-5mcg / kg / h）输注；组2（n = 30）的患者也接受异丙酚（5-6 mg / kg / h）联合芬太尼（3-5 mcg / kg / h）输注，但同时在主动脉阻断前和开放后15分钟分别给予6％地氟醚吸入 ; 组3（n = 30）患者接受异丙酚（2-3 mg / kg / h）联合芬太尼（3-5 mcg / kg / h）输注，并连续6％地氟醚吸入。 分别于术前（S1），体外循环阻断主动脉前（S2），开放后（S3）和手术后24 h（S4）时抽取血样。
结 果
所有组在年龄和BMI（体重指数）方面相似（p> 0.05）。 S3时的TNF-α水平与S1，S2及S4时相比明显增高（p> 0.001）。 组3中TNF-α水平与组1和组2相比明显降低（p <0.05）。 在所有组中，h-FABP水平在S3时增加，但在S4时显着降低（p <0.05）。 在组3中，S2和S3的h-FABP水平显着低于组1（p <0.05）。 h-FABP和TNF-α水平之间存在中度相关性（Spearman's rho = 0.472，p <0.001）。
结 论
通过对h-FABP和TNF-α的测量，低剂量异丙酚联合地氟醚持续吸入比单独使用异丙酚或短时程的地氟醚吸入在治疗CABG患者上提供更有效的预处理。
原始文献摘要
Onk D; Ozcelik F; Kuyrukluyildiz U; Gunay M; Onk A; Ayazoglu TA; Coban A; Alagol A. The effect of desflurane and propofol protocols on preconditioningAdvances in Clinical & Experimental Medicine. 26(5):817-823,Aug 2017 .
Background：Preconditioning is one of the most powerful mechanisms preventing the myocardial isch-emic damage that occurs during coronary artery bypass grafting.
Method.：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 com-pared 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 continu-ous desflurane inhalation provide more effective preconditioning than propofol alone or a short course of desflurane in patients undergoing CABG. 麻醉学文献进展分享 联系我们