Preconditioning With Repeated Hyperbaric Oxygen Induces Myocardial and Cerebral Protection in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Prospective, Randomized, Controlled Clinical Trial
Preconditioning With Repeated Hyperbaric Oxygen Induces Myocardial and Cerebral Protection in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Prospective, Randomized, Controlled Clinical Trial
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反复高压氧预处理可对接受冠状动脉搭桥手术的患者产生心肌和大脑保护：一项前瞻性、随机、对照临床试验
DOI：
10.1053/j.jvca.2011.06.017
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发表时间：
2011-12-01
影响因子：
2.8
通讯作者：
Xiong, Lize
中科院分区：
文献类型：
--
作者：
Li, Yang;Dong, Hailong;Xiong, Lize
目的：评价高压氧预处理在体外循环和非体外循环冠状动脉旁路移植术中对脑和心肌的保护作用。设计：一项前瞻性、随机、单盲研究，包括2007年12月至2009年2月期间计划进行择期体外循环或非体外循环手术的患者。设置：一所三级护理大学教学医院。参与者：49名择期体外循环或非体外循环冠状动脉旁路移植术患者。干预措施：患者被随机分配到对照组（15例患者接受体外循环手术，10例患者接受非体外循环手术）或高压氧（HBO; 14例患者接受体外循环手术，10例患者接受非体外循环手术）组。在HBO组的患者进行预处理5 days before surgery. Measures和主要结果：在泵冠状动脉旁路移植术患者预处理HBO有显着降低S100 B蛋白，神经元特异性烯醇化酶，肌钙蛋白I围手术期血清水平与泵对照组相比。术后，体外高压氧组患者在重症监护室的住院时间缩短，并减少了正性肌力药物的使用。与体外循环对照组相比，术后24小时血清过氧化氢酶活性显著升高。在非体外循环组中，任何相同参数均无差异。结论：HBO预处理可产生脑和心脏保护作用，这是通过神经元和心肌损伤的生化标志物以及接受体外循环冠状动脉旁路移植术的患者的临床结局来确定的。在非体外循环冠状动脉旁路移植术中没有观察到保护作用。(C)2011 Elsevier Inc. All rights reserved.
Objectives:To evaluate the cerebral and myocardial protective effects of hyperbaric oxygen preconditioning in both on-pump and off-pump coronary artery bypass graft surgery.Design: A prospective, randomized, single-blinded study including patients scheduled for elective on-pump or off-pump surgery between December 2007 and February 2009.Setting: A tertiary care university teaching hospital.Participants: Forty-nine elective on-pump or off-pump coronary artery bypass graft surgery patients.Interventions: Patients were randomized to either the control (15 patients with on-pump procedure and 10 patients with off-pump procedure, respectively) or hyperbaric oxygen (HBO; 14 patients with on-pump procedure and 10 patients with off-pump procedure, respectively) groups. Patients in the HBO groups underwent preconditioning for 5 days before surgery.Measurements and Main Results: On-pump coronary artery bypass graft surgery patients preconditioned with HBO had significant decreases in S100B protein, neuron-specific enolase, and troponin I perioperative serum levels compared with the on-pump control group. Postsurgically, patients in the on-pump HBO group had a reduced length of stay in the intensive care unit and a decreased use of inotropic drugs. Serum catalase activity 24 hours postoperatively was significantly increased compared with the on-pump control group. In the off-pump groups, there was no difference in any of the same parameters.Conclusions: Preconditioning with HBO resulted in both cerebral and cardiac protective effects as determined by biochemical markers of neuronal and myocardial injury and clinical outcomes in patients undergoing on-pump coronary artery bypass graft surgery. No protective effects were noted in off-pump coronary artery bypass graft surgery. (C) 2011 Elsevier Inc. All rights reserved.