S-Space College of Medicine/School of Medicine (의과대학/대학원) Dept. of Medicine (의학과) Theses (Master's Degree_의학과)
Effect of ischemic preconditioning with postconditioning on postoperative lung function in patients undergoing cardiac surgery involving cardiopulmonary bypass
심폐우회술을 이용한 심장 수술 환자에서 원격 허혈성 전조건화 및 후조건화가 수술 후 폐기능에 미치는 영향
- 의과대학 의학과
- Issue Date
- 서울대학교 대학원
- 학위논문 (석사)-- 서울대학교 대학원 : 의학과 마취통증의학 전공, 2013. 2. 오아영.
- Background: Remote ischemic preconditioning is a protective mechanism in which transient ischemia to a distant organ protects the subsequent sustained ischemia-reperfusion injury of a target organ. We hypothesized that remote ischemic preconditioning with postconditioning (RIPC) might alleviate the pulmonary dysfunction after cardiac surgery involving cardiopulmonary bypass (CPB).
Methods: A total of 76 patients who underwent elective cardiac surgery involving CPB were randomized into the control group or RIPC group. In the RIPC group, four cycles of 5-min ischemia and 5-min reperfusion were administered two times to the upper limb: before CPB and after CPB. The primary endpoint was to compare the lung function evaluated by PaO2/FIO2 ratio and the secondary endpoint was to compare the other pulmonary variables between the two groups at postoperative 6, 12, 18, 24 hours.
Results: The mean PaO2/ FIO2 value was significantly higher in the RIPC group than in the control group at 24 hour after operation (290 ± 96 vs. 387 ± 137, p = 0.001) and the proportion of patients under mechanical ventilation longer than 48 hours was significantly higher in the control group (23 % vs. 3 % , p < 0.05). However, there were no significant differences on other parameters including oxygenation at other time points, systemic inflammatory markers, postoperative mechanical ventilation time and duration of ICU stay.
Conclusion: RIPC improved oxygenation at postoperative 24 hours and decreased the number of patients requiring ventilator care longer than 48 hours in patients undergoing elective cardiac surgery involving CPB. However, to determine the clinical significance of these protective effects, further studies would be required.