Relationship Between Perioperative Carotid Blood Flow Monitoring and Cerebral Function Protection in Cardiac Surgery
Condition: Coronary Artery Bypass Grafting; Cardiopulmonary Bypass
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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）.
    

Intervention name(s): Nicardipine; normal saline
Intervention type(s): Drug; Other
Intervention description(s): Nicardipine 0.2-0.5μg/(kg·min) was infused at the beginning of CPB.; It has the same capacity as group N。
Other intervention name(s): Astellas Pharmaceuticals (China) Co., LTD；Sinopharm approved number J20160048/ Registration number H20160015; Hunan Kelun Pharmaceutical Co., LTD；Sinopharm approved H43020456
Intervention MeSH terms: Nicardipine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment