Effect of remote ischemic perconditioning on inflammation and oxidative stress in patients undergoing cardiac valve replacement with cardiopulmonary bypass_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 DENG Huiwei , PAN Daobo , ZHOU Aiguo , HUANG Furong , GUO Huajing , MENG Zexian , ZHANG Xiongfei , LIU Hongbo , DAI Jing , WANG Xianxue

Department of Anesthesiology, First People’s Hospital of Changde, Changde, 415003, Hunan, P.R.China;

Corresponding?author：

DENG Huiwei, Email: dhw_4823@163.com

Keywords：

Cardiopulmonary bypass; remote ischemic perconditioning; inflammation; oxidative stress

DOI：

10.7507/1007-4848.201609043

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Objective To evaluate the effect of remote ischemic perconditioning on inflammation and oxidative stress in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB). Methods Sixty adult patients undergowent cardiac valve replacement under CPB. There were 29 males and 31 females with an age ranging from 40–60 years and weight from 45–70 kg. They were randomly divided into 2 groups (n=30 in each) by random number generator: a control group (group C, 14 males and 16 females) and a remote ischemic perconditioning group (group R, 15 males and 15 females). Anesthesia was induced with intravenous injection of midazolam, fentanyl, vecuronium. The patients were mechanically ventilated after endotracheal intubation. Anesthesia was maintained with intravenous injection of midazolam, fentanyl, vecuronium and inhalation of sevoflurane. Three cycles of 5-min ischemia and 5-min reperfusion were performed on the right lower extremity immediately after aortic occlusion by means of a tourniquet in group R. A tourniquet was only placed under the right lower extremity in group C. Before CPB and at 0, 1, 6 and 24 h after termination of CPB (T_0-4), blood samples were obtained from the right internal jugular vein for determination of levels of serum IL-6, IL-10, SOD and MDA and the count of white blood cell and the percentage of monocytes. The bladder temperature was measured at T_0-4 and SIRS score was evaluated on preoperative 1 d and postperative 1, 2 and 3 d. Tracheal extubation time and length of ICU stay were record. Results Compared with group C, the concentration of serum IL-6 at T1-3, the concentration of MDA at T₁, the count of leukocyte T₃, the bladder temperature at T₄ and the SIRS scores on postperative 1 d were significantly decreased, while the concentration of serum IL-10 at T₂-T₃, the SOD activity at T₁-T₂, and the percentage of monocyte at T₃-T₄ were significantly increased in group R (P<0.05). Tracheal extubation time and length of ICU stay in group R were significantly shorter than those of group C (P<0.05). Conclusion Remote ischemic perconditioning can reduce inflammation and oxidative stress and improve post-operative recovery in patients undergoing cardiac valve replacement with CPB.

1.	Sitniakowsky LS, Later AF, van de Watering LM, et al. The effect of RBC transfusions on cytokine gene expression after cardiac surgery in patients developing post-operative multiple organ failure. Transfus Med, 2011, 21(4): 236-246.
2.	Jouan J, Golmard L, Benhamouda N, et al. Gene polymorphisms and cytokine plasma levels as predictive factors of complications after cardiopulmonary bypass. J Thorac Cardiovasc Surg, 2012,144(2):467-473.
3.	Machado LB, Negri EM, Bonafé WW, et al. Evaluation of cytokine levels and pulmonary function in patients undergoing coronary artery bypass graft. Rev Bras Anestesiol, 2011, 61(3): 275-285.
4.	張義軒, 馬傳根, 趙景霞, 等. 利多卡因聯合參附注射液對體外循環致全身炎性反應的影響. 上海醫學, 2008, 31(3): 165-168.
5.	Schmidt MR, Smerup M, Konstantinov IE, et al. Intermittent peripheral tissue ischemia during coronary ischemia reduces myocardial infarction through a K-ATP-dependent mechanism:first demonstration of remote ischemic preconditioning.Am J Physiol Heart Circ Physiol, 2007, 292(4): H1883-H1890.
6.	Hu Q, Luo W, Huang L, et al. Multiorgan protection of remote ischemic perconditioning in valve replacement surgery. J Surg Res, 2016, 200(1): 13-20.
7.	Ren C, Li N, Wang B, et al. Limb ischemic perconditioning attenuates blood-brain barrier disruption by inhibiting activity of MMP-9 and occludin degradation after focal cerebral ischemia. Aging Dis, 2015, 6(6): 406-417.
8.	Czigány Z, Turóczi Z, ónody P, et al. Remote ischemic perconditioning protects the liver from ischemia-reperfusion injury. J Surg Res, 2013, 185(2): 605-613.
9.	Sedaghat Z, Kadkhodaee M, Seifi B, et al. Hepatoprotective effects of remote perconditioning during renal ischemia. Bratisl Lek Listy, 2014, 115(11): 675- 679.
10.	鄧恢偉, 潘道波. 遠隔缺血時處理對體外循環心臟瓣膜置換術患者全身炎性反應的影響. 中華麻醉學雜志, 2013, 33(5): 534-536.
11.	Yang NY, Shi L, Zhang Y, et al. Ischemic preconditioning reduces transplanted submandibular gland injury. J Surg Res, 2013,179(1): e265-e273.
12.	Liou HL, Shih CC, Chao YF, et al. Inflammatory response to colloids compared to crystalloid priming in cardiac surgery patients with cardiopulmonary bypass. Chin J Physiol, 2012, 55(3): 210-218.
13.	Sipos W, Duvigneau C, Sterz F, et al. Changes in interleukin-10 mRNA expression are predictive for 9-day survival of pigs in an emergency preservation and resuscitation model. Resuscitation, 2010, 81(5): 603-608.
14.	NeSmith EG, Weinrich SP, Andrews JO, et al. Systemic inflammatory response syndrome score and race as predictors of length of stay in the intensive care unit. Am J Crit Care, 2009,18(4): 339-346.
15.	Craig DG, Reid TW, Martin KG, et al. The systemic inflammatory response syndrome and sequential organ failure assessment scores are effective triage markers following paracetamol (acetaminophen) overdose. Aliment Pharmacol Ther, 2011, 34(2): 219-228.
16.	Shin HS, Kim SP, Han SH,et al.Prognostic Indicators for Acute Liver Failure Development and Mortality in Patients with Hepatitis A: Consecutive Case Analysis.Yonsei Med J, 2014, 55(4): 953-959.

1. Sitniakowsky LS, Later AF, van de Watering LM, et al. The effect of RBC transfusions on cytokine gene expression after cardiac surgery in patients developing post-operative multiple organ failure. Transfus Med, 2011, 21(4): 236-246.
2. Jouan J, Golmard L, Benhamouda N, et al. Gene polymorphisms and cytokine plasma levels as predictive factors of complications after cardiopulmonary bypass. J Thorac Cardiovasc Surg, 2012,144(2):467-473.
3. Machado LB, Negri EM, Bonafé WW, et al. Evaluation of cytokine levels and pulmonary function in patients undergoing coronary artery bypass graft. Rev Bras Anestesiol, 2011, 61(3): 275-285.
4. 張義軒, 馬傳根, 趙景霞, 等. 利多卡因聯合參附注射液對體外循環致全身炎性反應的影響. 上海醫學, 2008, 31(3): 165-168.
5. Schmidt MR, Smerup M, Konstantinov IE, et al. Intermittent peripheral tissue ischemia during coronary ischemia reduces myocardial infarction through a K-ATP-dependent mechanism:first demonstration of remote ischemic preconditioning.Am J Physiol Heart Circ Physiol, 2007, 292(4): H1883-H1890.
6. Hu Q, Luo W, Huang L, et al. Multiorgan protection of remote ischemic perconditioning in valve replacement surgery. J Surg Res, 2016, 200(1): 13-20.
7. Ren C, Li N, Wang B, et al. Limb ischemic perconditioning attenuates blood-brain barrier disruption by inhibiting activity of MMP-9 and occludin degradation after focal cerebral ischemia. Aging Dis, 2015, 6(6): 406-417.
8. Czigány Z, Turóczi Z, ónody P, et al. Remote ischemic perconditioning protects the liver from ischemia-reperfusion injury. J Surg Res, 2013, 185(2): 605-613.
9. Sedaghat Z, Kadkhodaee M, Seifi B, et al. Hepatoprotective effects of remote perconditioning during renal ischemia. Bratisl Lek Listy, 2014, 115(11): 675- 679.
10. 鄧恢偉, 潘道波. 遠隔缺血時處理對體外循環心臟瓣膜置換術患者全身炎性反應的影響. 中華麻醉學雜志, 2013, 33(5): 534-536.
11. Yang NY, Shi L, Zhang Y, et al. Ischemic preconditioning reduces transplanted submandibular gland injury. J Surg Res, 2013,179(1): e265-e273.
12. Liou HL, Shih CC, Chao YF, et al. Inflammatory response to colloids compared to crystalloid priming in cardiac surgery patients with cardiopulmonary bypass. Chin J Physiol, 2012, 55(3): 210-218.
13. Sipos W, Duvigneau C, Sterz F, et al. Changes in interleukin-10 mRNA expression are predictive for 9-day survival of pigs in an emergency preservation and resuscitation model. Resuscitation, 2010, 81(5): 603-608.
14. NeSmith EG, Weinrich SP, Andrews JO, et al. Systemic inflammatory response syndrome score and race as predictors of length of stay in the intensive care unit. Am J Crit Care, 2009,18(4): 339-346.
15. Craig DG, Reid TW, Martin KG, et al. The systemic inflammatory response syndrome and sequential organ failure assessment scores are effective triage markers following paracetamol (acetaminophen) overdose. Aliment Pharmacol Ther, 2011, 34(2): 219-228.
16. Shin HS, Kim SP, Han SH,et al.Prognostic Indicators for Acute Liver Failure Development and Mortality in Patients with Hepatitis A: Consecutive Case Analysis.Yonsei Med J, 2014, 55(4): 953-959.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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