Nicardipine In Surgical Patients On Cardiopulmonary Bypass Perfusion And Gastrointestinal Effects Of Cytokines

PurposeDiscussion nicardipine on gastric mucosal blood flow during cardiopulmonary bypass perfusion affect systemic hemodynamics and oxygenation index cytokine levels.MethodJanuary 2012 to January 2014 selected hospital cardiac surgery routinely treated for 48 patients undergoing valve replacement surgery in patients with rheumatic heart disease for the retrospective analysis, and they were divided into general anesthesia group (control group) and nicardipine group (observation group) 24 cases each. Two groups of patients underwent routine induction of anesthesia right jugular vein and insert a Swan-Ganz catheter was placed under endoscopic guidance chronometry,24h continuous monitoring of patients with gastric carbon dioxide partial pressure (PgCO2). Control group intraoperative intravenous anesthesia and cardiopulmonary bypass conventional methods; observed after induction of anesthesia in patients with sustained speed 0.5μg/kg/min pump horizon, surgery to maintain mean arterial pressure (MAP)≥ 70mmHg. Continuous monitoring of patients with intraoperative hemodynamics. Patients were in position before the cycle (T1), started turning after 30min (T2), after the shutdown 30min (T3) and at the end of surgery (T4) were measured in patients with venous oxygen saturation (SvO2), arerial blood was measured delivery of oxygen(DO2), consumption of oxygen (VO2) and pH, arterial partial pressure of CO2 in the calculation of the gastric mucosa (Pg-a CO2). Were drawn at various time points above the level of serum interleukin-6,18 (IL-6,18) and tumor necrosis factor-a (TNF-a) blood enzyme-linked immunosorbent assay,Result(1) two hemodynamic parameters:two groups of patients T3, T4 point in cardiac index (CI) were higher than T1 (P<0.05). The patients T3, T4 point CI was significantly higher (P<0.05). In the control group, T2, T3 point in systemic vascular resistance index (SVRI) decreased significantly compared with T1 (P<0.05). In the observation group, T2, T3, T4 point SVRI was significantly lower than T1, the difference was statistically significant(P<0.05), and the observation group than the control group at T4 SVRI(P <0.05).(2) systemic oxygenation index:SvO2 compared two groups of patients was significantly higher in T1 T2, while the control group at T3, T4 decreased significantly when compared with T1 (P<0.05). SvO2 observation group in T4 significantly to the control group, the difference was statistically significant (P<0.05). Patients in both groups at T2 DO2, VO2 increased (P<0.05), the control group in T3, T4 point DO2, VO2 remained unchanged, whereas DO2 have statistically significant difference (P<0.05) about the observation group in T3, T4 point than the foundation phase.(3) gastrointestinal perfusion index:Two groups of patients were significantly decreased compared with the T2 T1 point PgCO2 and Pg-aCO2 (P<0.05), while the pH value is significantly higher than the T1, the difference was statistically significant (P <0.05). In the control group, T3, T4 and Pg-aCO2 point PgCO2 significantly higher than the T1, and significantly higher than in the observation group (P<0.05). PH values in the control group, T3, T4 point< 7.35, while the observation group> 7.35.(4) serum cytokines:control group, T3, T4 point of serum IL-6, IL-18, and TNF-a was significantly higher than T1, and the control group was significantly higher than in the observation group at the same time point, the difference was statistically significant (P <0.05).Conclusion.(1) during cardiopulmonary bypass heart valve replacement surgery can lead to patients oxygenation disorders, gastrointestinal tissue hypoperfusion and elevated serum inflammatory cytokines, resulting in damage to the gastrointestinal mucosa of patients.(2) nicardipine can improve heart valve replacement surgery in patients with extracorporeal oxygenation disorders, gastrointestinal tissue hypoperfusion and inflammatory cytokine levels, reducing the gastrointestinal mucosa low perfusion injury.(3) air tonometry monitoring gastrointestinal perfusion is non-invasive, sensitive indicators, can promote the use of anesthesia in clinical work.