冠脉搭桥手术中TIVA与挥发性麻醉:对炎症和认知结果的影响。

IF 2.1 4区 医学 Q2 ANESTHESIOLOGY
Vipan Garg, Gautham Patel, Banashree Mandal, Shubhkarman Kahlon, Goverdhan Dutt Puri, Shyam Kst, Amit Rawat
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引用次数: 0

摘要

目的:比较全静脉麻醉(TIVA)与挥发性麻醉下行择期冠状动脉旁路移植术(CABG)的成人患者围手术期炎症反应和早期神经认知结局。设计:前瞻性、随机对照试验。环境:三级保健学术医疗中心。参与者:50名年龄在18 - 65岁的成人患者,计划进行选择性无泵搭桥手术。干预措施:患者随机接受基于异丙酚的TIVA (P组)或基于七氟醚的挥发性麻醉(S组)。所有患者均遵循标准化手术和体外循环方案。测量方法及主要结果:术前及术后24、48小时测定血清白细胞介素-6 (IL-6)水平。次要结局包括简易精神状态检查评分、通气时间、血管活性肌力评分、肾功能和重症监护病房住院时间。两组IL-6水平在24小时显著升高,48小时显著降低,各时间点组间差异无统计学意义。在24和48小时时,TIVA组的精神状态检查分数明显高于TIVA组。TIVA也与较短的机械通气时间相关。两组间VIS、心功能、肾脏参数和重症监护病房住院时间具有可比性。结论:TIVA与挥发性麻醉在CABG患者围术期的IL-6反应相似。然而,TIVA与术后早期更好的认知功能和更快的机械通气相关。这些发现提示TIVA在这类手术人群中具有潜在的神经认知益处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
TIVA vs Volatile Anesthesia in CABG Surgery: Effects on Inflammatory and Cognitive Outcomes.

Objectives: To compare the perioperative inflammatory response and early neurocognitive outcomes in adult patients undergoing elective coronary artery bypass grafting (CABG) under total intravenous anesthesia (TIVA) versus volatile anesthesia.

Design: Prospective, randomized controlled trial.

Setting: A tertiary care academic medical center.

Participants: Fifty adult patients aged 18 to 65 years scheduled for elective on-pump CABG surgery.

Interventions: Patients were randomized to receive either propofol-based TIVA (Group P) or sevoflurane-based volatile anesthesia (group S). Standardized surgical and cardiopulmonary bypass protocols were followed in all patients.

Measurements and main results: Serum interleukin-6 (IL-6) levels were measured preoperatively and at 24 and 48 hours postoperatively. Secondary outcomes included Mini-Mental State Examination scores, ventilation duration, vasoactive-inotropic score, renal function, and intensive care unit stay. IL-6 levels had increased significantly at 24 hours and decreased by 48 hours in both groups, with no significant intergroup difference at any time point. Mini-Mental State Examination scores at 24 and 48 hours were significantly higher in the TIVA group. TIVA was also associated with shorter mechanical ventilation duration. VIS, cardiac function, renal parameters, and intensive care unit stay duration were comparable between groups.

Conclusions: TIVA and volatile anesthesia resulted in similar perioperative IL-6 responses in patients undergoing CABG. However, TIVA was associated with better early postoperative cognitive function and faster emergence from mechanical ventilation. These findings suggest a potential neurocognitive benefit of TIVA in this surgical population.

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来源期刊
CiteScore
4.80
自引率
17.90%
发文量
606
审稿时长
37 days
期刊介绍: The Journal of Cardiothoracic and Vascular Anesthesia is primarily aimed at anesthesiologists who deal with patients undergoing cardiac, thoracic or vascular surgical procedures. JCVA features a multidisciplinary approach, with contributions from cardiac, vascular and thoracic surgeons, cardiologists, and other related specialists. Emphasis is placed on rapid publication of clinically relevant material.
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