Remote ischaemic preconditioning on gene expression and circulating proteins after subacute laparoscopic cholecystectomy: randomized clinical trial.

IF 3.5 3区 医学 Q1 SURGERY BJS Open Pub Date : 2024-07-02 DOI:10.1093/bjsopen/zrae067
Kirsten L Wahlstrøm, Lukas Balsevicius, Hannah F Hansen, Madeline Kvist, Jakob Burcharth, Gry Skovsted, Jens Lykkesfeldt, Ismail Gögenur, Sarah Ekeloef
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引用次数: 0

Abstract

Background: Surgical stress may lead to postsurgical hypercoagulability, endothelial dysfunction and systemic inflammation, which can impact on patient recovery. Remote ischaemic preconditioning is a procedure that activates the body's endogenous defences against ischaemia and reperfusion injury. Studies have suggested that remote ischaemic preconditioning has antithrombotic, antioxidative and anti-inflammatory effects. The hypothesis was that remote ischaemic preconditioning reduces surgery-induced systemic stress response.

Method: During a 24-month period (2019-2021), adult patients undergoing subacute laparoscopic cholecystectomy due to acute cholecystitis were randomized to remote ischaemic preconditioning or control. Remote ischaemic preconditioning was performed less than 4 h before surgery on the upper arm. It consisted of four cycles of 5 min ischaemia and 5 min reperfusion. The gene expression of 750 genes involved in inflammatory processes, oxidative stress and endothelial function was investigated preoperatively and 2-4 h after surgery in both groups. In addition, changes in 20 inflammation- and vascular trauma-associated proteins were assessed preoperatively, 2-4 h after surgery and 24 h after surgery.

Results: A total of 60 patients were randomized. There were no statistically significant differences in gene expression 2-4 h after surgery between the groups (P > 0.05). Remote ischaemic preconditioning did not affect concentrations of circulating proteins up to 24 h after surgery (P > 0.05).

Conclusion: The study did not demonstrate any effect of remote ischaemic preconditioning on expression levels of the chosen genes or in circulating immunological cytokines and vascular trauma-associated proteins up to 24 h after subacute laparoscopic cholecystectomy in patients with acute cholecystitis.

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亚急性腹腔镜胆囊切除术后远程缺血预处理对基因表达和循环蛋白的影响:随机临床试验。
背景:手术应激可能导致术后高凝状态、内皮功能障碍和全身炎症,从而影响患者的康复。远程缺血预处理是一种激活机体内源性防御缺血和再灌注损伤的程序。研究表明,远程缺血预处理具有抗血栓、抗氧化和抗炎作用。假设远程缺血预处理可降低手术引起的全身应激反应:在为期24个月(2019-2021年)的时间里,因急性胆囊炎接受亚急性腹腔镜胆囊切除术的成年患者被随机分配到远程缺血预处理或对照组。远程缺血预处理在手术前不到4小时在上臂进行。它包括 5 分钟缺血和 5 分钟再灌注的四个周期。对两组患者术前和术后 2-4 小时内涉及炎症过程、氧化应激和内皮功能的 750 个基因的表达进行了调查。此外,还评估了术前、术后 2-4 小时和术后 24 小时 20 种炎症和血管创伤相关蛋白的变化:结果:共有 60 名患者接受了随机治疗。两组患者术后 2-4 小时的基因表达差异无统计学意义(P>0.05)。远程缺血预处理对术后 24 小时内的循环蛋白浓度没有影响(P > 0.05):结论:该研究未显示远程缺血预处理对急性胆囊炎患者亚急性腹腔镜胆囊切除术后24小时内所选基因的表达水平或循环免疫细胞因子和血管创伤相关蛋白有任何影响。
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BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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