The Relationship Between Inflammatory Cytokines And Oxygen Free Radicals With Risk Factors Of Pressure Injury In Patients Undergoing Cardiovascular Surgery

Objective:To analyze the risk factors of pressure injuries in patients undergoing cardiovascular surgery with cardiopulmonary bypass,so that we could provide the basis for nurses to protect the patients from pressure injuries.Then to explore the changes of inflammatory cytokines and oxygen free radicals expression in patients undergoing cardiovascular surgery with cardiopulmonary bypass at different periods based on the mechanism of pressure injuries,and to analyze the correlation between inflammatory cytokines and oxygen free radicals with risk factors of pressure injuries,we could provide new ideas for the prevention and treatment of pressure injuries in patients undergoing cardiovascular surgery.Methods:In the first stage: we reviewed the electronic medical records,anesthesia system data,and extracorporeal circulation data with all patients who underwentcardiovascular surgery with cardiopulmonary bypass considered in a class-three grade A hospital of Guangxi from January 2016 to December 2016.A self-designed questionnaire about risk factors for pressure injuries was used to collect data.The questionnaire included three parts.The first part showed the general information for patients.The second part reviewed the factors related to pressure injuries through literatures.The third part presented the condition of pressure injuries,including the occurrence of pressure injuries,the stage,site and area of pressure injuries.Based on whether the patients developed pressure injuries,the patients were divided into two groups,the pressure injuries group and the non-group pressure injuries.Univariate analysis and the multivariate analysis was used to analyze the risk factors of pressure injuries.In the second stage: the patients undergoing valvular disease of the hear surgery with cardiopulmonary bypass from July 2016 to April 2017 in a grade III A hospital in Guangxi were included as study objects.Firstly,We collected the general demographic data.Secondly,radial arterial blood(3ml per patient)was collected at three different time points,including before anesthesia induction(T1),20 min after aortic clamping time(T2),and at the end of cardiopulmonary bypass(T3).After the operation,the patients were divided into the pressure injuries group and the non-group pressure injuries according to with pressure injuries or not.Then the pressure injuries group had thirty patients,other thirty patients without were selected pressure injuries at random become non-group pressure injuries.Elisa tests were used to detect the expression of inflammatory cytokines(TNF-a,IL-6,hs-CRP)and oxygen free radicals(MDA).Finally,The correlation between inflammatory cytokines and oxygen free radicals with risk factors for pressure injuries were analyzed.Results:In the first stage: Of 288 eligible patients,56 developed pressure injuries,for an incidence of 19.4%.Of these,52 were rated as stage 1,two as stage 2,and two as deep tissue injury.The incidence of pressure injuries in patients with various disease types was 18.8% for coronary artery disease,19.0% for valvular heart disease,28.6% for thoracic aortic aneurysm,and 19.0% for congenital heart disease respectively.Univariate analysis showed that there were significant differences in diabetes,hypertension,operative time,duration of cardiopulmonary bypass,and the intraoperative use of vasoactive drugs(P>0.05).Multivariate analysis showed that diabetes,intraoperative use of vasoactive drugs and cardiopulmonary bypass duration were the risk factors of pressure injuries.The second stage:1.General information and extracorporeal circulation time : there was no statistically significant difference ingeneral information(P>0.05).The mean extracorporeal circulation time(154.47±58.81 min)in the pressure injuries group was higher than that in the non-pressure injuries group(111.73±42.22min),and the difference was statistically significant(P<0.05).2.Comparison of Inflammatory cytokine and free radicals concentration in two Groups:(1)Plasma TNF-a concentration: Comparison between groups,the concentration of TNF-a in the group of pressure injuries at the end of cardiopulmonary bypass(T3)was higher than the non-pressure injuries group,the difference was statistically significant(P< 0.01).In-group comparison,the plasma TNF-a concentration obtained at the end of cardiopulmonary bypass(T3)was significantly higher than those at 20 min after aortic clamping time(T2)(P< 0.01);obtained 20 min after aortic clamping time(T2)and at the end of cardiopulmonary bypass(T3)was significantly higher than those before incision but after induction of anesthesia(T1)(P<0.05).(2)Plasma IL-6 concentration: Comparison between groups,the concentration of IL-6 in the group of pressure injuries at the end of cardiopulmonary bypass(T3)was significantly higher than the non-pressure injuries group,the difference was statistically significant(P<0.01).In-group comparison,the plasma IL-6 concentration obtained at the end of cardiopulmonary bypass(T3)was significantly higher than those at 20 min after aortic clamping time(T2)(P<0.01);obtained 20 min after aortic clamping time(T2)and at the end of cardiopulmonary bypass(T3)was significantly higher than those before incision but after induction of anesthesia(T1)(P<0.05).(3)Plasma hs-CRP concentration: Comparison between groups,there was no significant difference between the two groups in the plasma hs-CRP concentration obtained at 20 min after aortic clamping time(T2),and at the end of cardiopulmonary bypass(T3)(P>0.05).In-group comparison,the plasma hs-CRP concentration obtained at the end of cardiopulmonary bypass(T3)was similar to those at 20 min after aortic clamping time(T2)(P>0.05);obtained 20 min after aortic clamping time(T2)and at the end of cardiopulmonary bypass(T3)was significantly higher than those before incision but after induction of anesthesia(T1)(P<0.05).(4)Plasma MDA concentration: Comparison between groups,the concentration of plasma MDA in the pressure injuries group at 20 min after aortic clamping time(T2)and at the end of cardiopulmonary bypass(T3)was higher than the non-pressure injuries group,the difference was statistically significant(P<0.05).In-group comparison,the plasma MDA concentrationobtained at the end of cardiopulmonary bypass(T3)was significantly higher than those at 20 min after aortic clamping time(T2)(P<0.01);obtained 20 min after aortic clamping time(T2)and at the end of cardiopulmonary bypass(T3)was significantly higher than those before incision but after induction of anesthesia(T1)(P<0.05)3.Correlation analysis: The expression of inflammatory cytokines(TNF-a,IL-6,hs-CRP)and oxygen free radicals(MDA)in T3 was positively correlated to the duration of cardiopulmonary bypass.The correlation coefficients were0.896,0.732,0.420 and 0.590 respectively.Conclusion:1.Diabetes,intraoperative use of vasoactive drugs and extracorporeal circulation time are independent risk factors of pressure injuries in patients undergoing cardiovascular surgery with cardiopulmonary bypass.Prolonged cardiopulmonary bypass is associated with an increased incidence of pressure injuries.2.The expression of inflammatory cytokines(TNF-a,IL-6)and oxygen free radical(MDA)were related to pressure injuries in patients undergoing cardiac surgery with cardiopulmonary bypass.3.The expression of inflammatory cytokines(TNF-a,IL-6,hs-CRP)and oxygen free radicals(MDA)increased with the increase duration of cardiopulmonary bypass.