| BackgroundThe perioperative period of off-pump coronary artery bypass grafting（OPCAB）is affected by factors such as mechanical ventilation,blood transfusion,hypothermia,surgery,anesthesia,ischemia reperfusion and other factors,leading to inflammatory stress in the lungs,A cascade reaction,and then lung injury,which is currently one of the important reasons for OPCAB patients’perioperative death or long-term stay in the Intensive Care Unit（ICU）.Therefore,it is of great significance to explore the possible inflammatory pathway mechanism of OPCAB perioperative lung injury and lung protection drugs.ObjectiveTo observe the effect of dexmedetomidine on the possible inflammatory signal pathway mediated by the plasma receptor for advanced glycation end-products（RAGE）in patients with off-pump coronary artery bypass grafting.Methods1.Participants From October 28,2019 to August 25,2020,patients who underwent beating coronary artery bypass grafting at the Department of Cardiac and Great Vascular Surgery of Luoyang Central Hospital,30 cases were enrolled according to the criteria for inclusion,exclusion and exclusion,Using a random number table,they are divided into Dex（group D）and control group（group C）,each with 15 cases.2.Anesthesia management Both groups of patients were induced by intravenous general anesthesia,maintained by intravenous pumping of propofol,sufentanil and inhaled sevoflurane,and intermittent intravenous injection of cisatracurium.In group D,dexmedetomidine 1.0μg/（kg·h）was injected intravenously 10 min before induction of anesthesia,and dexmedetomidine 0.5μg/（kg·h）was continuously injected intravenously to maintain the same period.Give the same amount of normal saline;record at 5 time points:T1（after induction of anesthesia）,T2（before anastomosis）,T3（6 h after surgery）,T4（24 h after surgery）,and T5（48 h after surgery）The patient’s mean arterial pressure（MAP）,heart rate（HR）,arterial oxygen partial pressure（Pa O2）,arterial carbon dioxide partial pressure（Pa CO2）,and the patient’s mechanical ventilation time and residence time in the intensive care unit（ICU）were recorded.3.The specimens were collected at the above 5 time points,and 3 ml of internal jugular venous blood was collected,and enzyme-linked immunosorbent assay（ELISA）was used to determine the plasma high mobility group protein B1（HMGB-1）and receptor for advanced glycation end-products（RAGE）and interleukin 6（IL-6）.4.All continuous variables,normally distributed data,are expressed as mean±standard deviation;non-normally distributed variables are described as median（interquartile range）or number（percentage）.All data were analyzed with SPSS22（IBM,USA）,and P<0.05 was considered statistically significant.Results1.General information,the baseline data of the two groups of patients,such as age,male to female ratio,body mass index,comorbidities,American Association of Anesthesiologists（ASA）classification and left ventricular ejection fraction were not statistically significant（P>0.05）.2.Comparing the preoperative and intraoperative data,the intraoperative use of propofol in group D was less than that in group C（P<0.05）;the detention time in the intensive care unit of group D was shorter than that of group C（P<0.05）.3.Comparing the HR group,the two groups of patients have the slowest heart rate at T2,group D is at T2,and group C is at T2 and T3.The heart rate of patients is slower than T1（P<0.05）;comparison between groups,the two groups are at T1-T5 There was no difference in heart rate（P>0.05）.4.Compared within the MAP group,the average arterial pressure of the two groups of patients at T2-T5 was lower than that of T1（P<0.05）,and T4 was the lowest;comparison between the two groups,there was no difference in the average arterial pressure of the two groups of patients at T1-T5（P>0.05）.5.Compared with Pa O2 group,the two groups of patients have the highest arterial oxygen partial pressure at T1.Compared with T1,group D is at T4 and T5,and group C is at T2-T5.There is a difference in arterial oxygen partial pressure（P<0.05）;Comparing between groups,there was no difference in the partial pressure of arterial blood oxygen between the two groups of patients at T1-T5（P>0.05）.6.Compared with Pa CO2 group,the two groups of patients have gradually increased the arterial carbon dioxide partial pressure at T1-T5.Compared with T1,the D group has a difference in T2-T5 and the C group has a difference in the T3-T5 arterial carbon dioxide partial pressure（P<0.05）;Comparing between groups,there was no difference between the two groups of patients in the T1-T5 arterial carbon dioxide partial pressure（P>0.05）.7.Compared with the plasma HMGB-1 group,the two groups of patients gradually increased in T1-T5,compared with T1,the two groups had differences in T2-T5（P<0.05）;comparison between the groups,the D group had a low T5 in group C（P<0.05）.8.In comparison of plasma RAGE group,both groups of patients gradually increased in T1-T4,compared with T1,group D was at T2-T4,group C was at T2-T5,there was a difference（P<0.05）;comparison between groups,Group D is lower than group C at T5（P<0.05）.9.In comparison of plasma IL-6 group,both groups of patients gradually increased in T1-T4,compared with T1,the two groups had differences in T2-T5（P<0.05）;comparison between groups,D group had a low T4 in group C（P<0.05）.ConclusionMain outcome:In OPCAB operation,the application of Dex may reduce the levels of plasma HMGB-1,RAGE,and IL-6,inhibit the RAGE-mediated nuclear factor-κB（NF-κB）inflammatory signaling pathway,and exert anti-inflammatory effects.secondary outcome:In OPCAB operation,the application of Dex has a certain sedative and analgesic effect,and at the same time can reduce the patient’s pulmonary inflammation and reduce the patient’s postoperative ICU retention time. |
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