Anesthetics to Prevent Lung Injury in Cardiac Surgery: A Randomized Controlled Trial.
Anesthetics to Prevent Lung Injury in Cardiac Surgery: A Randomized Controlled Trial.
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DOI：
10.1053/j.jvca.2022.04.018
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发表时间：
2022-10
影响因子：
2.8
通讯作者：
中科院分区：
文献类型：
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作者：
探讨七氟醚麻醉在预防肺部炎症和术后肺部并发症方面是否优于丙泊酚。随机对照试验。单一三级护理大学医院。四十名成年人正在接受体外循环心脏手术。患者按照 1:1 的比例随机分配，接受七氟烷或异丙酚维持麻醉。在搭桥之前和之后对血液和支气管肺泡灌洗液进行取样，以使用生物标志物组测量肺部炎症。支气管肺泡灌洗液中肿瘤坏死因子α（TNFα）浓度的变化是主要结果。次要结局包括肺部炎症（定义为其他生物标志物的变化）和术后肺部并发症。支气管肺泡灌洗液 TNFα 浓度的变化在各组之间没有显着差异（中位 [IQR] 变化，17.24 [1.11–536.77] vs 101.51 [1.47–402.84] pg/mL，七氟烷 vs 异丙酚，p = 0.31）。旁路后血浆白细胞介素 8 浓度显着降低（中位 [IQR]，53.92 [34.5–55.91] v 66.92 [53.03–94.44] pg/mL，p = 0.04），旁路后血浆高级糖基化终产物受体的增加显着较小（中位 [IQR]，174.59）与异丙酚相比，七氟醚组为 [73.59–446.06] v 548.22 [193.15–852.39] pg/mL，p = 0.03）。两组术后肺部并发症发生率为100%，其中胸腔积液发生率较高（17/18 [94.44%] vs 19/22 [86.36%]，p = 0.39），低氧血症发生率较高（16/18 [88.88%] vs 22/22 [100%]，p = 0.11）。与异丙酚相比，心脏手术期间七氟醚麻醉并不能始终如一地预防肺部炎症或预防术后肺部并发症。七氟醚组中肺损伤和炎症特异性的 2 种血浆生物标志物水平显着降低。
To investigate if sevoflurane based anesthesia is superior to propofol in preventing lung inflammation and preventing postoperative pulmonary complications. Randomized controlled trial. Single tertiary care university hospital. Forty adults undergoing cardiac surgery with cardiopulmonary bypass. Patients were randomized in a 1:1 ratio to anesthetic maintenance with sevoflurane or propofol. Blood and bronchoalveolar lavage fluid was sampled before and after bypass to measure pulmonary inflammation using a biomarker panel. The change in bronchoalveolar lavage concentration of tumor necrosis factor alpha (TNFα) was the primary outcome. Secondary outcomes included lung inflammation defined as changes in other biomarkers and postoperative pulmonary complications. There were no significant differences between groups in the change in bronchoalveolar lavage TNFα concentration (median [IQR] change, 17.24 [1.11–536.77] v 101.51 [1.47–402.84] pg/mL, sevoflurane v propofol, p = 0.31). There was a significantly lower postbypass concentration of plasma interleukin 8 (median [IQR], 53.92 [34.5–55.91] v 66.92 [53.03–94.44] pg/mL, p = 0.04) and a significantly smaller postbypass increase in the plasma receptor for advanced glycosylation end products (median [IQR], 174.59 [73.59–446.06] v 548.22 [193.15–852.39] pg/mL, p = 0.03) in the sevoflurane group compared with propofol. The incidence of postoperative pulmonary complications was 100% in both groups, with high rates of pleural effusion (17/18 [94.44%] v 19/22 [86.36%], p = 0.39) and hypoxemia (16/18 [88.88%] v 22/22 [100%], p = 0.11). Sevoflurane anesthesia during cardiac surgery did not consistently prevent lung inflammation or prevent postoperative pulmonary complications compared to propofol. There were significantly lower levels of 2 plasma biomarkers specific for lung injury and inflammation in the sevoflurane group.
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影响因子：
158.5
作者：
Landoni, Giovanni;Lomivorotov, Vladimir V.;Zangrillo, Alberto
通讯作者：
Zangrillo, Alberto
影响因子：
38.9
作者：
Jabaudon M;Blondonnet R;Pereira B;Cartin-Ceba R;Lichtenstern C;Mauri T;Determann RM;Drabek T;Hubmayr RD;Gajic O;Uhle F;Coppadoro A;Pesenti A;Schultz MJ;Ranieri MV;Brodska H;Mrozek S;Sapin V;Matthay MA;Constantin JM;Calfee CS
通讯作者：
Calfee CS
影响因子：
8.8
作者：
Canet, Jaume;Gallart, Lluis;Sanchis, Joaquin
通讯作者：
Sanchis, Joaquin
影响因子：
1.9
作者：
Potocnik, Iztok;Jankovic, Vesna Novak;Klokocovnik, Tomislav
通讯作者：
Klokocovnik, Tomislav
影响因子：
120.7
作者：
Dieleman, Jan M.;Nierich, Arno P.;van Dijk, Diederik
通讯作者：
van Dijk, Diederik