首次在高危患者心脏手术中联合使用一氧化氮和分子氢的经验

Q4 Medicine
V. Pichugin, A. V. Deryugina, S. Domnin, A. S. Shirshin, S. A. Fedorov, S. N. Buranov, S. A. Jourko, M. Ryazanov, Yu.D. Brichkin, D. A. Danilova
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During the postoperative period, clinical and functional indicators were studied (dynamics of myocardial contractile function according to ultrasound data); duration of artificial pulmonary ventilation (ALV); stay in the intensive care unit; hospital stay; mortality; level of marker of myocardial injury – troponin I (cTnI). Myocardial injury index (MII) was calculated to assess the degree of injury.Results. It was found that the level of cTnI in the postoperative period increased statistically significantly in all groups but was statistically significantly lower in Groups 2 and 3 compared to Group 1 at the end of the surgery and 12 and 24 hours after the surgery. Also, level of cTnI was statistically significantly lower in Group 3 at all stages of the study compared to Group 1 and after 12, 24 and 48 hours compared to Group 2. Statistically significantly lower MII values were revealed at all stages of the postoperative period in Group 3 compared with Groups 1 and 2. Changes in indicators of myocardial contractile function suggest an earlier and more complete recovery in Groups 2 and 3 (the changes were statistically significantly higher than that in Group 1). In Groups 2 and 3, the incidence of acute heart failure was statistically significantly lower (p = 0.046) compared to Group 1, according to Fisher’s exact test. There were no statistically significant differences in the incidence of acute respiratory and multiple organ failure in Groups 2 and 3 compared to Group 1. Also, patients of Groups 2 and 3 did not experience any complications in the early postoperative period. In Group 3, there was a statistically significant decrease in the duration of mechanical ventilation and stay in the intensive care unit after surgery compared to Group 2.Conclusion. 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引用次数: 0

摘要

该研究的目的是评估在整个心肺旁路(CPB)过程中向心肺旁路机的气气混合输送管道中联合供应一氧化氮(NO)(40 ppm)和氢气(1.2 ppm)对心肌保护的有效性。研究对象包括在心肺旁路和药物冷心麻痹下进行心脏手术的患者(n = 91)。患者被随机分为 3 组。第1组(n = 30)为对照组。第 2 组(n = 28)和第 3 组(n = 33)分别在体外红外回路中单独供应 NO(40 ppm)和联合供应 NO(40 ppm)和氢气(1.2 ppm)。在术后期间,对临床和功能指标(根据超声波数据显示的心肌收缩功能动态)、人工肺通气(ALV)持续时间、在重症监护室的停留时间、住院时间、死亡率、心肌损伤标志物肌钙蛋白 I(cTnI)的水平进行了研究。计算心肌损伤指数(MII)以评估损伤程度。结果发现,术后各组的 cTnI 水平均有显著上升,但与第一组相比,第二组和第三组在手术结束时、术后 12 小时和 24 小时的 cTnI 水平均有显著下降。此外,与第 1 组相比,第 3 组 cTnI 水平在研究的所有阶段都明显降低,与第 2 组相比,在 12、24 和 48 小时后也明显降低。 与第 1 组和第 2 组相比,第 3 组 MII 值在术后所有阶段都明显降低。心肌收缩功能指标的变化表明,第 2 组和第 3 组的恢复更早、更彻底(与第 1 组相比,这些变化在统计学上明显更高)。根据费舍尔精确检验,与第一组相比,第二组和第三组的急性心力衰竭发生率明显降低(P = 0.046)。此外,第 2 组和第 3 组患者在术后早期没有出现任何并发症。与第 2 组相比,第 3 组术后机械通气时间和在重症监护室的住院时间在统计学上有显著缩短。与标准技术相比,向红外回路单独供应 NO 具有额外的心脏保护作用,术后期间肌钙蛋白 I 水平的降低和心肌收缩功能指标的较小变化在统计学上证实了这一点。与单独供应 NO 相比,向红外回路联合供应 NO 和分子氢对心肌的保护作用更明显,这体现在术后肌钙蛋白 I 和 MII 的统计水平更低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The first experience of the combined use of nitric oxide and molecular hydrogen for cardiac surgery in high-risk patients
The purpose of the study was to evaluate the effectiveness of myocardial protection with a combined supply of nitric oxide (NO) (40 ppm) and hydrogen (1.2 ppm) into the gas-air mixture delivery line of the cardiopulmonary bypass (CPB) machine during the entire period of CPB.Methods. The study included patients (n = 91) who had cardiac surgery under cardiopulmonary bypass and pharmacological cold cardioplegia. Patients were randomized into 3 groups. The Group 1 (n = 30) was control. Groups 2 (n = 28) and 3 (n = 33) received an isolated supply of NO (40 ppm) and a combined supply of NO (40 ppm) and hydrogen (1.2 ppm) into the extracorporeal IR circuit, respectively. During the postoperative period, clinical and functional indicators were studied (dynamics of myocardial contractile function according to ultrasound data); duration of artificial pulmonary ventilation (ALV); stay in the intensive care unit; hospital stay; mortality; level of marker of myocardial injury – troponin I (cTnI). Myocardial injury index (MII) was calculated to assess the degree of injury.Results. It was found that the level of cTnI in the postoperative period increased statistically significantly in all groups but was statistically significantly lower in Groups 2 and 3 compared to Group 1 at the end of the surgery and 12 and 24 hours after the surgery. Also, level of cTnI was statistically significantly lower in Group 3 at all stages of the study compared to Group 1 and after 12, 24 and 48 hours compared to Group 2. Statistically significantly lower MII values were revealed at all stages of the postoperative period in Group 3 compared with Groups 1 and 2. Changes in indicators of myocardial contractile function suggest an earlier and more complete recovery in Groups 2 and 3 (the changes were statistically significantly higher than that in Group 1). In Groups 2 and 3, the incidence of acute heart failure was statistically significantly lower (p = 0.046) compared to Group 1, according to Fisher’s exact test. There were no statistically significant differences in the incidence of acute respiratory and multiple organ failure in Groups 2 and 3 compared to Group 1. Also, patients of Groups 2 and 3 did not experience any complications in the early postoperative period. In Group 3, there was a statistically significant decrease in the duration of mechanical ventilation and stay in the intensive care unit after surgery compared to Group 2.Conclusion. Isolated supply of NO into the IR circuit has an additional cardioprotective effect, which is confirmed by statistically lower levels of troponin I and smaller changes in the indicators of myocardial contractile function during the postoperative period compared to standard technology. A more pronounced protective effect on the myocardium was shown with the combined supply of NO and molecular hydrogen to the IR circuit as seen by statistically lower levels of troponin I and MII in the postoperative period compared with the isolated supply of NO.
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来源期刊
Pulmonologiya
Pulmonologiya Medicine-Pulmonary and Respiratory Medicine
CiteScore
1.40
自引率
0.00%
发文量
70
期刊介绍: The aim of this journal is to state a scientific position of the Russian Respiratory Society (RRS) on diagnosis and treatment of respiratory diseases based on recent evidence-based clinical trial publications and international consensuses. The most important tasks of the journal are: -improvement proficiency qualifications of respiratory specialists; -education in pulmonology; -prompt publication of original studies on diagnosis and treatment of respiratory diseases; -sharing clinical experience and information about pulmonology service organization in different regions of Russia; -information on current protocols, standards and recommendations of international respiratory societies; -discussion and consequent publication Russian consensus documents and announcement of RRS activities; -publication and comments of regulatory documents of Russian Ministry of Health; -historical review of Russian pulmonology development. The scientific concept of the journal includes publication of current evidence-based studies on respiratory medicine and their discussion with the participation of Russian and foreign experts and development of national consensus documents on respiratory medicine. Russian and foreign respiratory specialists including pneumologists, TB specialists, thoracic surgeons, allergists, clinical immunologists, pediatricians, oncologists, physiologists, and therapeutists are invited to publish article in the journal.
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