Effect of Hyperbaric Oxygen Pretreatment on Systemic Inflammatory Response after Extracorporeal Circulation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WUFan ¹ , ZHOUKai ⁴ , GAOFeng ¹ , ZHANGJin-bao ¹ , FUXi ² , GUOXin ³ ,  HEChun-yang ²

1. Department of Cardiovascular Surgery, General Hospital of Chengdu Military Region, Chengdu 610083, P. R. China;
2. Department of Hyperbaric Oxygen, General Hospital of Chengdu Military Region, Chengdu 610083, P. R. China;
3. Central Laboratory, General Hospital of Chengdu Military Region, Chengdu 610083, P. R. China;
4. Department of Cardiac Surgery, Kanghua Hospital Dongguan, Dongguan 523080 Guangdong, P. R. China;

Corresponding author：

HEChun-yang, Email: chyh42@126.com

Keywords：

Hyperbaric oxygen; Pretreatment; Heart; Extracorporeal circulation; Inflammatory response

DOI：

10.7507/1007-4848.20150254

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Objective To observe the effect of preoperative hyperbaric oxygen (HBO) pretreatment on systemic inflammatory response after extracorporeal circulation. Methods A total of 30 patients who were going to receive mitral or aortic valve replacement were randomly allocated into a control group (group C, n=15) and a pretreatment group (group P, n=15).Three sessions of HBO pretreatments were given to the patients in the group P before operation. The changes of serum concentration of inflammatory factors including tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, P-selectin, intercellular adhesion molecule (ICAM)-1, heat shock protein (HSP)-70 between the two groups were compared at four time points:before incision of skin (T1), 30 min after ECC(T2), 1 h (T3) and 24 h (T4) after the end of ECC. Results There was no statistical difference in the serum concentration of IL-6,TNF-α, P-selectin, ICAM-1, IL-10, and HSP-70 at T1 between the two groups (P>0.05). The level of all inflammatory factors ascended in first and descended at last in both groups, which reached a peak at T3 and descended at T4. But the serum concentration at T4 was still higher than the level at T1 (P<0.05). There was a statistical difference in serum level of HSP-70 between T4 and T1 (373.3±96.7 pg/ml vs. 316.3±55.5 pg/ml, P<0.05). There were statistical differences in serum concentration of IL-6 (141.5±25.9 pg/ml vs. 119.2±31.8 pg/ml), HSP-70 (449.8±48.3 pg/ml vs. 373.3±96.7 pg/ml), and IL-10 (64.2±8.2 pg/ml vs. 90.3±14.2 pg/ml) between the group C and the group P at T4 (P<0.05). There was no statistical difference between the two groups in postoperative ICU stay time and thoracic drainage. While time of postoperative ventilation in the group P was shorter than that in the group C with a statistical difference (11.4±5.6 days vs. 15.8±5.1 days, P<0.05). Conclusion Hyperbaric oxygen pretreatment before operation can abate the bad inflammatory response after heart valve replacement surgery to some extent and strengthen the anti-inflammatory protection, thereby favoring the reduction in postoperative complications.

Citation： WUFan, ZHOUKai, GAOFeng, ZHANGJin-bao, FUXi, GUOXin, HEChun-yang. Effect of Hyperbaric Oxygen Pretreatment on Systemic Inflammatory Response after Extracorporeal Circulation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(11): 1022-1025. doi: 10.7507/1007-4848.20150254 Copy

1.	Asimakopoulos G.The inflammatory response to ECC:the role of leukocyte filtration.Perfusion,2002,17(suppl):7-10.
2.	Jordan JE,Zhao ZQ,Vinten-Johanse J.The role of neutrophils in myocardial ischemia-reperfusion injury.Cardiovasc Res,1999,43(4):860-878.
3.	Kawahiyo K,Kobavashi E,Ohmori M,et al.Enhanced responsiveness of circulatory neutrophils after cardiopulmonary bypass:increased aggregation and superoxide producing capacity.Artif Organs,2000,24(1):37-42.
4.	李扬,杨博,陈敏,等.高压氧预处理对冠状动脉搭桥手术患者术后早期认知功能的影响.陕西医学杂志,2011,40(5):551-554,570.
5.	李扬,杨博,陈敏,等.高压氧预处理对冠状动脉旁路移植手术的心肌保护作用.心脏杂志,2011,23(5):636-640.
6.	Alex J,Laden G,Cale AR,et al.Pretreatment with hyperbaric oxygen and its effect on neuropsychometric dysfunction and systemic inflammatory response after cardiopulmonary bypass:a prospective randomized double-blind trial.J Thorac Cardiovasc Surg,2005,130(6):1623-1630.
7.	Wan S,LeClerc JL,Vincent JL.Inflammatory response to cardiopulmonary bypass:mechanisms involved and possible therapeutic strategies.Chest,1997,112(3):676-692.
8.	Boyle EM Jr,Pohlman TH,Johnson MC,et al.Endothelial cell injury in cardiovascular surgery:the systemic inflammatory response.Ann Thorac Surg,1997,63(1):277-284.
9.	凡小庆,王瑞婷.细胞因子与体外循环肺损伤的研究进展.临床肺科杂志,2014,19(5):892-894.
10.	Sainz IM,Pixley RA,Colman RW.Fifty years of research on the plasma kallikrein-kinin system:from protein structure and function to cell biology and in-vivo pathophysiology.Thromb Haemost,2007,98(1):77-83.
11.	Warren OJ,Smith AJ,Alexiou C,et al.The inflammatory response to cardiopulmonary bypass:part 1——mechanisms of pathogenesis.Cardiothorac Vasc Anesth,2009,23(2):223-231.
12.	Svyatets M,Tolani K,Zhang M,et al.Perioperative management of deep hypothermic circulatory arrest.J Cardiothorac Vasc Anesth,2010,24(4):644-655.
13.	Kats S,Schonberger JP,Brands R,et al.Endotoxin release in cardiac surgery with cardiopulmonary bypass:pathophysiology and possible therapeutic strategies.An update.Eur J Cardiothorac Surg,2011,39(4):451-458.
14.	Hennein HA,Ebba H,Rodriguez JL,et al.Relationship of the proinflammatory cytokines to myocardial ischemia and dysfunction after uncomplicated coronary revascularization.J Thorac Cardiovasc Surg,1994,108(4):626-635.
15.	Lee CW,Lin CC,Luo SF,et al.Tumor necrosis factor-alpha enhances neutrophil adhesiveness:induction of vascular cell adhesion molecule-1 via activation of Akt and CaM kinase Ⅱ and modifications of histone acetyltransferase and histone deacetylase 4 in human tracheal smooth muscle cells.Mol Pharmacol,2008,73(5):1454-1464.
16.	Sun M,Chen M,Dawood F,et al.Tumor necrosis factor-alpha mediates cardiac remodeling and ventricular dysfunction after pressure overload state.Circulation,2007,115(11):1398-1407.
17.	Hall RI,Smith MS,Rocker G.The systemic inflammatory response to cardiopulmonary bypass:pathophysiological,therapeutic and pharmacological considerations.Anesth Analg,1997,85(4):766-782.
18.	Li QB,Li JS,Zhang LF,et al.Preconditioning with hyperbaric oxygen induces tolerance against oxidative injury via increased expression of heme oxygenase-1 in primary cultured spinal cord neurons.Life Sciences,2007,80(12):1087-1093.
19.	邓鸿敖,张红艳.严重烧伤等应激状态下细胞外热休克蛋白70对免疫系统的影响.广东医学,2014,35(7):1113-1115.
20.	Pierpaolo G,Sabino S,Emma B,et al.Myocardial and lung injury after cardiopulmonary bypass:role of interleukin(IL)-10.Ann Thorac Surg,2003,76(1):117-123.

1. Asimakopoulos G.The inflammatory response to ECC:the role of leukocyte filtration.Perfusion,2002,17(suppl):7-10.
2. Jordan JE,Zhao ZQ,Vinten-Johanse J.The role of neutrophils in myocardial ischemia-reperfusion injury.Cardiovasc Res,1999,43(4):860-878.
3. Kawahiyo K,Kobavashi E,Ohmori M,et al.Enhanced responsiveness of circulatory neutrophils after cardiopulmonary bypass:increased aggregation and superoxide producing capacity.Artif Organs,2000,24(1):37-42.
4. 李扬,杨博,陈敏,等.高压氧预处理对冠状动脉搭桥手术患者术后早期认知功能的影响.陕西医学杂志,2011,40(5):551-554,570.
5. 李扬,杨博,陈敏,等.高压氧预处理对冠状动脉旁路移植手术的心肌保护作用.心脏杂志,2011,23(5):636-640.
6. Alex J,Laden G,Cale AR,et al.Pretreatment with hyperbaric oxygen and its effect on neuropsychometric dysfunction and systemic inflammatory response after cardiopulmonary bypass:a prospective randomized double-blind trial.J Thorac Cardiovasc Surg,2005,130(6):1623-1630.
7. Wan S,LeClerc JL,Vincent JL.Inflammatory response to cardiopulmonary bypass:mechanisms involved and possible therapeutic strategies.Chest,1997,112(3):676-692.
8. Boyle EM Jr,Pohlman TH,Johnson MC,et al.Endothelial cell injury in cardiovascular surgery:the systemic inflammatory response.Ann Thorac Surg,1997,63(1):277-284.
9. 凡小庆,王瑞婷.细胞因子与体外循环肺损伤的研究进展.临床肺科杂志,2014,19(5):892-894.
10. Sainz IM,Pixley RA,Colman RW.Fifty years of research on the plasma kallikrein-kinin system:from protein structure and function to cell biology and in-vivo pathophysiology.Thromb Haemost,2007,98(1):77-83.
11. Warren OJ,Smith AJ,Alexiou C,et al.The inflammatory response to cardiopulmonary bypass:part 1——mechanisms of pathogenesis.Cardiothorac Vasc Anesth,2009,23(2):223-231.
12. Svyatets M,Tolani K,Zhang M,et al.Perioperative management of deep hypothermic circulatory arrest.J Cardiothorac Vasc Anesth,2010,24(4):644-655.
13. Kats S,Schonberger JP,Brands R,et al.Endotoxin release in cardiac surgery with cardiopulmonary bypass:pathophysiology and possible therapeutic strategies.An update.Eur J Cardiothorac Surg,2011,39(4):451-458.
14. Hennein HA,Ebba H,Rodriguez JL,et al.Relationship of the proinflammatory cytokines to myocardial ischemia and dysfunction after uncomplicated coronary revascularization.J Thorac Cardiovasc Surg,1994,108(4):626-635.
15. Lee CW,Lin CC,Luo SF,et al.Tumor necrosis factor-alpha enhances neutrophil adhesiveness:induction of vascular cell adhesion molecule-1 via activation of Akt and CaM kinase Ⅱ and modifications of histone acetyltransferase and histone deacetylase 4 in human tracheal smooth muscle cells.Mol Pharmacol,2008,73(5):1454-1464.
16. Sun M,Chen M,Dawood F,et al.Tumor necrosis factor-alpha mediates cardiac remodeling and ventricular dysfunction after pressure overload state.Circulation,2007,115(11):1398-1407.
17. Hall RI,Smith MS,Rocker G.The systemic inflammatory response to cardiopulmonary bypass:pathophysiological,therapeutic and pharmacological considerations.Anesth Analg,1997,85(4):766-782.
18. Li QB,Li JS,Zhang LF,et al.Preconditioning with hyperbaric oxygen induces tolerance against oxidative injury via increased expression of heme oxygenase-1 in primary cultured spinal cord neurons.Life Sciences,2007,80(12):1087-1093.
19. 邓鸿敖,张红艳.严重烧伤等应激状态下细胞外热休克蛋白70对免疫系统的影响.广东医学,2014,35(7):1113-1115.
20. Pierpaolo G,Sabino S,Emma B,et al.Myocardial and lung injury after cardiopulmonary bypass:role of interleukin(IL)-10.Ann Thorac Surg,2003,76(1):117-123.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of Hyperbaric Oxygen Pretreatment on Systemic Inflammatory Response after Extracorporeal Circulation

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