Общая реаниматология (Dec 2018)
Dynamics of Cognitive Functions and Proinflammatory Cytokines in Different Variants of Coronary Artery Bypass Surgery
Abstract
Purpose of the study: to evaluate the parameters of cognitive potential and systemic proinflammatory response during direct myocardial revascularization surgery on a beating heart and under conditions of various types of extracorporeal circulation (classical cardiopulmonary bypass and minimized extracorporeal circuit).Materials and methods. A total of 205 patients aged 41–76 years (56.16±2.91 years) were examined. All patients were screened by the Montreal Cognitive Assessment and underwent contrast-enhanced CT perfusion imaging of the brain. The concentrations of tumor necrosis factor, interleukins-6 and 8, and neuron specific enolase were measured in the perioperative period. Surgery in all patients was performed under general balanced anesthesia based on sevoflurane. All patients were randomly divided into three groups: the patients after off-pump surgery; the patients after surgery with classical cardiopulmonary bypass; the patients after surgery with a minimized extracorporeal circuit. Off-pump surgery was performed using a tissue stabilizer. Cardiopulmonary bypass using membrane oxygenators was performed in a nonpulsatile regimen with a perfusion index of 2.4 l/(min•m2) under moderate hypothermia (34–35°C). Protection of the myocardium during the period of aortic cross-clamping was carried out by pharmacological cold cardioplegia.Results. Seven days after surgery, the lowest Montreal Cognitive Assessment scoring was found in a group of patients operated using the classical cardiopulmonary bypass. In this group, the decline was almost 23 % (P=0.0202) compared with the baseline. In the same group, the increase in the level of neuron specific enolase reached 43.19% (P=0.0047). One day after surgery, the highest values (P<0.05) of tumor necrosis factor, interleukin-6 and interleukin-8 were found in the group of patients who underwent surgery with the classical cardiopulmonary bypass. Cortisol levels 24 hours after surgery also increased in all groups, but the smallest increase was recorded in the group of patients undergoing the off-pump surgery.Conclusion. Off-pump surgery or the use of the minimized extracorporeal circuit with biocompatible coating, centrifugal pump in the absence of blood contact with air minimally affects the cognitive potential of patients, reduces manifestations of the systemic inflammatory response, which, in turn, reduces a number of postoperative complications and improves the results of treatment.
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