Relationship Between Perioperative Carotid Blood Flow Monitoring and Cerebral Function Protection in Cardiac Surgery
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 64
- 试验地点
- 1
- 主要终点
- Internal carotid blood flow
研究概览
简要总结
Postoperative cognitive dysfunction (POCD) is a common complication of cardiac surgery, mainly manifested as mental confusion, anxiety, personality change and memory impairment, which seriously affects the quality of life of patients after surgery.Attention should be paid to the protection of neurological function in patients undergoing cardiac surgery during perioperative period.Nicardipine can selectively act on coronary arteries and cerebral vessels, increase coronary artery and cerebral blood flow, relieve coronary heart disease angina pectoris, protect brain tissue.The cerebral protective effect of nicardipine on cardiovascular surgery under CPB deserves further clinical study.About 15-20% of cardiac output (CO) in healthy adults is allocated to the brain , and cerebral blood flow is supplied by bilateral internal carotid artery (ICA) and vertebral artery (VA), among which ICA provides about 70%-80% of cerebral perfusion flow .However, the location of the internal carotid artery is superficial, the anatomical variation is less, and the ultrasonic Doppler technique is portable and simple to measure. It may be of certain clinical value to use the ultrasonic detection technology to quickly evaluate the cerebral perfusion during the perioperative period, and to early detect and avoid the intraoperative brain function injury.
详细描述
Patients who were scheduled to undergo open-heart surgery under cardiopulmonary bypass were randomly divided into nicardipine group (group N) and normal saline control group (group C) by the digital table method. Group N was pumped with nicardipine 0.2-0.5μg/(kg·min) after CPB, while group C was given the same volume of normal saline. The basic hemodynamic parameters, rScO2, BIS, maximum systolic velocity of internal carotid artery (PSV-ICA), end-diastolic velocity of internal carotid artery (EDV-ICA), diameter of internal carotid artery (D-ICA), internal carotid artery blood flow (Q-ICA) and cerebral blood flow ratio (CBF/CO) were observed and recorded in the two groups at each time point ), cerebrovascular resistance (CVR) and the concentration of NSE, a biomarker of brain injury.The following hypothesis is proposed: during CPB, pump nicardipine can dilate the internal carotid artery and cerebral arterioles, increase cerebral blood flow, improve cerebral oxygen supply, and reduce the risk of postoperative cognitive dysfunction(POCD).
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 60 Years 至 80 Years(Adult, Older Adult)
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •1: Age 60-80
- •2: ASA Ⅱ-Ⅲ, NYHAⅠ-Ⅲ, EF ≥50%
- •3: CABG under cardiopulmonary bypass
排除标准
- •1: Patients who had second heart surgery
- •2: Patients with intellectual disabilities, deafness or other impairments in normal communication
- •3: Previous neurosurgical procedures and history of cerebral infarction
- •5: Patients with moderate to severe carotid artery stenosis before operation
- •6: Patients with obvious abnormal liver and kidney function affecting drug metabolism
- •7: Patients taking psychotropic drugs
- •8: Alcoholism, drug addiction, drug dependence
- •9: The cardiopulmonary bypass time was greater than 120 minutes
研究组 & 干预措施
group N
Nicardipine was infused after initiation of CPB
干预措施: Nicardipine (Drug)
group C
Give the same volume of normal saline
干预措施: normal saline (Other)
结局指标
主要结局
Internal carotid blood flow
时间窗: After cardiopulmonary bypass
Blood flow through the internal carotid artery was measured per minute by ultrasound
次要结局
- Regional cerebral oxygen(After cardiopulmonary bypass)
- Mini-mental State Examination scale score(7 days after surgery.)
- Neuron specific endase(2 hours after surgery.)
研究者
Hongwei Shi
Head of the anesthesia department
Nanjing First Hospital, Nanjing Medical University
