Postoperative neurocognitive dysfunction in patients undergoing cardiac surgery after remote ischemic preconditioning: a double-blind randomized controlled pilot study.
Postoperative neurocognitive dysfunction in patients undergoing cardiac surgery after remote ischemic preconditioning: a double-blind randomized controlled pilot study.
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DOI：
10.1371/journal.pone.0064743
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Bein B
中科院分区：
文献类型：
--
作者：
Meybohm P;Renner J;Broch O;Caliebe D;Albrecht M;Cremer J;Haake N;Scholz J;Zacharowski K;Bein B
远端缺血预处理（RIPC）已被证明可以增强远端器官的耐受性，以应对随后的缺血事件。我们假设RIPC可减少接受复杂心脏手术的患者术后神经认知功能障碍（POCD）。我们进行了一项前瞻性、随机、双盲、对照试验，包括180例接受心肺转流术的择期心脏手术的成人患者。患者随机分为RIPC组和对照组。主要终点是术后5 - 7天通过综合测试组合评估的术后神经认知功能障碍。如果评估不同认知领域的2项或2项以上任务的术前与术后差异超过1个SD（1个SD标准），或如果合并Z评分≥ 1.96（Z评分标准），则假定认知变化。根据1 SD标准，52%的对照组和46%的RIPC患者在术后5 - 7天出现认知功能恶化（p = 0.753）。 与RIPC组（1.14 ± 4.02; p = 0.228）相比，对照组（2.16 ± 5.30）的Z评分总结显示出更多认知下降的趋势。 手术后3个月，神经认知功能障碍的发生率和严重程度在对照组和RIPC组之间没有差异。RIPC倾向于降低术后12小时[0.60（0.19 - 1.94）µ g/L vs. 0.48（0.07 - 1.84）µ g/L]和术后24小时[0.36（0.14 - 1.89）µ g/L vs. 0.26（0.07 - 0.90）µ g/L]的术后肌钙蛋白T释放。我们未能证明RIPC方案在接受各种心脏手术的患者中POCD的发生率和严重程度以及次要结局变量方面的有效性。因此，需要确定性的大规模多中心试验。ClinicalTrials.gov
Remote ischemic preconditioning (RIPC) has been shown to enhance the tolerance of remote organs to cope with a subsequent ischemic event. We hypothesized that RIPC reduces postoperative neurocognitive dysfunction (POCD) in patients undergoing complex cardiac surgery. We conducted a prospective, randomized, double-blind, controlled trial including 180 adult patients undergoing elective cardiac surgery with cardiopulmonary bypass. Patients were randomized either to RIPC or to control group. Primary endpoint was postoperative neurocognitive dysfunction 5–7 days after surgery assessed by a comprehensive test battery. Cognitive change was assumed if the preoperative to postoperative difference in 2 or more tasks assessing different cognitive domains exceeded more than one SD (1 SD criterion) or if the combined Z score was 1.96 or greater (Z score criterion). According to 1 SD criterion, 52% of control and 46% of RIPC patients had cognitive deterioration 5–7 days after surgery (p = 0.753). The summarized Z score showed a trend to more cognitive decline in the control group (2.16±5.30) compared to the RIPC group (1.14±4.02; p = 0.228). Three months after surgery, incidence and severity of neurocognitive dysfunction did not differ between control and RIPC. RIPC tended to decrease postoperative troponin T release at both 12 hours [0.60 (0.19–1.94) µg/L vs. 0.48 (0.07–1.84) µg/L] and 24 hours after surgery [0.36 (0.14–1.89) µg/L vs. 0.26 (0.07–0.90) µg/L]. We failed to demonstrate efficacy of a RIPC protocol with respect to incidence and severity of POCD and secondary outcome variables in patients undergoing a wide range of cardiac surgery. Therefore, definitive large-scale multicenter trials are needed. ClinicalTrials.gov NCT00877305
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