Pretreatment with hyperbaric oxygen and its effect on neuropsychometric dysfunction and systemic inflammatory response after cardiopulmonary bypass: A prospective randomized double-blind trial
Pretreatment with hyperbaric oxygen and its effect on neuropsychometric dysfunction and systemic inflammatory response after cardiopulmonary bypass: A prospective randomized double-blind trial
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DOI：
10.1016/j.jtcvs.2005.08.018
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发表时间：
2005-12-01
影响因子：
6
通讯作者：
Griffin, SC
中科院分区：
文献类型：
--
作者：
Alex, J;Laden, G;Griffin, SC
目的：动物研究表明，高压氧预处理可以诱导中枢神经系统缺血耐受，并调节炎症反应。我们评估了这种疗法在患者接受心肺bypass.Methods：64例患者前瞻性随机分为A组（n = 31;大气，1.5大气压绝对）或组B（n = 33;高压氧，2.4大气压绝对）在体外循环冠状动脉旁路移植术前。两组的年龄、性别、体重指数、糖尿病、高血压、吸烟、冠状动脉疾病严重程度、左心室功能、Parsonnet评分、Euroscore、搭桥时间、心肌缺血时间和移植物数量相当。B组中加拿大心血管学会心绞痛、纽约心脏协会呼吸困难和既往心肌梗死发生率显著较高。在手术前和搭桥术后2小时和24小时分析炎症标志物。在术前48小时和术后4个月进行神经心理测量测试，包括线索制作A和B、Rey听觉语言学习测试、凹槽钉板、信息处理表A和数字前后跨度。神经心理测量功能障碍定义为2次以上神经心理测量测试中超过1个SD恶化。卡方结果：A组术后炎性标志物可溶性E-选择素、CD 18和热休克蛋白70显著增加。在B组中未观察到这种情况。A组的神经心理功能障碍也明显高于B组。在任何其他早期术后临床outcome.Conclusions：我们的研究结果似乎表明，预处理与高压氧可以减少神经心理功能障碍，也调制体外循环后的炎症反应。然而，需要进一步的多中心随机试验来临床评估这种治疗形式。
Objective: Animal studies have shown that pretreatment with hyperbaric oxygen can induce central nervous system ischemic tolerance and also modulate the inflammatory response. We evaluated this therapy in patients undergoing cardiopulmonary bypass.Methods: Sixty-four patients were prospectively randomized to group A (n = 31; atmospheric air, 1.5 atmospheres absolute) or group B (n = 33; hyperbaric oxygen, 2.4 atmospheres absolute) before on-pump coronary artery bypass grafting. Age, sex, body mass index, diabetes, hypertension, smoking, coronary disease severity, left ventricular function, Parsonnet score, Euroscore, bypass time, myocardial ischemia time, and number of grafts were comparable in both groups. Canadian Cardiovascular Society angina, New York Heart Association dyspnea, and previous myocardial infarction were significantly higher in group B. Inflammatory markers were analyzed before surgery and 2 and 24 hours after bypass. Neuropsychometric testing was performed 48 hours before surgery and 4 months after surgery and included trail making A and B, the Rey auditory verbal learning test, grooved peg board, information processing table A, and digit span forward and backward. Neuropsychometric dysfunction was defined as more than 1 SD deterioration in more than 2 neuropsychometric tests. Chi-square. tests, Fisher tests, t tests, and analysis of variance were used as appropriate for statistical analysis.Results: Group A had a significant postoperative increase in the inflammatory markers Soluble E-selectin, CD 18, and heat shock protein 70. This was not observed in group B. Neuropsychometric dysfunction was also significantly higher in group A compared with group B. There was no difference in any other early postoperative clinical outcome.Conclusions: Our results seem to indicate that pretreatment with hyperbalic oxygen can reduce neuropsychometric dysfunction and also modulate the inflammatory response after cardiopulmonary bypass. However, further multicenter randomized trials are needed to clinically evaluate this form of therapy.