Clinical Study On Protective Effect Of Desflurane Post-conditioning On Myocardial Ischemia Reperfusion Injury

Objective:To probe into the protective effect of desflurane post-conditioning on myocardial ischemia reperfusion injury.Methods:A total of 40 patients（including male and female）underwent elective cardic-prodecure under general anesthesia in the Second Affiliated Hospital of the University of South China from January 2020 to January 2021 were selected as subjects,who were randomly divided into control group（Group C）and desflurane conditioning group（experimental group,Group D）（n=20）:In the desflurane conditioning group,5%desflurane was continuously inhaled with mechanical ventilation after the aorta and superior inferior cava opened with the oxigen flow at 6L·min^-1and 100%oxygen concentration,and PET desflurane concentration was monitored.Inhalation concentration was adjusted when PETdes reached 1MAC,and maintained for 10min.In the control group,pure oxygen was given at the same flow and concentration as experimental group for 10min,without desflurane.The levels of N-terminal pro-brain natriuretic peptide（NT-pro BNP）,interleukin-1β（IL-1β）,and tumor necrosis factor-α（TNF-α）in serum were detected immediately after anesthesia induction（T₁）and 1h（T₂）,6h（T₃）,12h（T₄）,and 24h（T₅）after aortic opening in the two groups with enzyme-linked immunosorbent assay（ELISA）.Right atrial appendage tissues was collected to measure the average fluorescence intensity of reactive oxygen species（ROS）before aortic cannula（T_a）and 1h after aortic opening（T_b）.Mean arterial pressure（MAP）and heart rate（HR）of patients in the two groups were recorded after entering the operating room（T₀）,immediately after anesthesia induction（T₁）,and 1h（T₂）,6h（T₃）,12h（T₄）,24h（T₅）,and 72h（T₆）after aortic opening.Preoperative cardiac ultrasound parameters including left ventricular ejection fraction（LVEF）and left ventricular fractional shortening（LVFS）were recorded,as well as the results of LVEF and LVFS after being transferred out of the intensive care unit（ICU）after surgery.Results:1.There were no significant differences in sex ratio,age,body mass index（BMI）,tranferring time and aortic crossclamp time between the two groups（P>0.05）.2.Comparison of NT-pro BNP,IL-1βand TNF-αbetween the two groups showed that the differences at T₂,T₃,T₄ and T₅ were statistically significant（P<0.05）,but not at T₁（P>0.05）.3.According to the analysis on the average fluorescence intensity of ROS,there was no statistical difference between the experimental group and the control group at T_a（P>0.05）,but there was statistical difference at T_b（P<0.05）.When comparing at T_a and T_b time points in group,the fluorescence intensity of ROS in the experimental group and the control group was statistically significant（P<0.05）.4.There were no statistically significant differences in HR and MAP at T₀,T₁ and T₂ between the two groups（P>0.05）,but there were statistically significant differences at T₃,T₄,T₅ and T₆（P<0.05）.Pairwise comparison:HR and MAP of the experimental group at T₃,T₄,T₅ and T₆ was compared to each other without statistically significant differences（P>0.05）,but there were statistically significant differences in HR of the control group at T₃,T₄,T₅ and T₆（P<0.05）,and no statistically significant differences in MAP of the control group at T₃,T₄,T₅ and T₆（P>0.05）.5.There were no statistically significant differences in LVEF and LVFS before surgery between the two groups（P>0.05）,but there were statistically significant differences after surgery（P<0.05）.According to the comparison of LVEF and LVFS of the experimental group and the control group in group,the differences before and after surgery was statistically significant（P<0.05）.Conclusions:Post-conditioning of desflurane has protective effect on myocardial ischemia reperfusion injury in patients undergoing cardiopulmonary bypass.