Background In recent years, clinical evidence has shown that excessive use of epinephrine may cause ischemia-reperfusion (I/R) injury of the patient’s nervous system. Epinephrine is a commonly used vasoactive agent in the field of cardiovascular surgery, and I/R injury of the nervous system is a common complication in patients with Stanford type A aortic dissection (TAAD) after Sun’s procedure. At present, the clinical research on the above two aspects mainly focuses on the macro level, and there is still a lack of research on micro aspects such as biomarkers.
Objective To investigate the influence of different doses of epinephrine on biomarkers for postoperative I/R injury of the nervous system in patients with TAAD.
Methods A retrospective analysis was performed for the clinical data of 158 patients with TAAD who underwent Sun’s procedure in Department of Cardiovascular Surgery, The First Medical center of Chinese PLA General Hospital, from January 2012 to January 2019, and according to the dose of epinephrine after surgery, the patients were divided into non-epinephrine group (19 male patients and 7 female patients, 42.8±12.9 years of age), low-dose (≤0.03 µg/kg·min) group (51 male patients and 12 female patients, 47.6±12.4 years of age), and high-dose (>0.03 µg/kg·min) group (55 male patients and 14 female patients, 50.7±12.2 years of age). The three groups were compared in terms of the changes in six biomarkers for I/R injury of the nervous system after epinephrine administration at different time points, i.e., interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), lactate dehydrogenase (LDH), monoamine oxidase (MAO), superoxide dismutase (SOD), and neuron specific enolase (NSE), and the influence of different doses of epinephrine on nervous system function was also evaluated.
Results There were no significant differences in baseline data between the three groups (all P >0.05). The high-dose group had the highest incidence rates of disturbance of consciousness (68.1%), sensory system abnormality (59.4%), and abnormal reflex (40.6%) at 48 hours after surgery, followed by the low-dose group (50.8%, 34.9%, and 23.8%, respectively) and the non-adrenaline group (19.2%, 0, and 7.6%, respectively), and there were significant differences between the groups (all P <0.05). There were no significant differences in all markers between the three groups at 0 hour (all P >0.05); at 48 hours after surgery, the high-dose group had the lowest level of LDH, followed by the low-dose group and the non-epinephrine group, and there were significant differences between the groups (all P <0.05); at 54 and 72 hours after surgery, the levels of the six markers increased significantly with the increase in the use of epinephrine, with significant differences between the groups (all P <0.05).
Conclusion For the patients with TAAD after Sun’s procedure, high-dose epinephrine has a negative impact on the nervous system after surgery, while low-dose epinephrine has a favorable safety profile and is more effective in the recovery of nervous system function.
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