七氟烷预处理对体外循环下心脏瓣膜置换术病人血清心肌损伤标志物的影响

Effects of sevoflurane preconditioning on serum myocardiac injury markers during perioperative period in patients undergoing cardiac valve replacement with cardiopulmonary bypass

关键词:  七氟烷  预处理  肌钙蛋白I  体外循环

Key words:  sevoflurane  preconditioning  cTnI  cardiopulmonary bypass

摘要:

目的　探讨七氟烷预处理对体外循环（CPB）下心脏瓣膜置换术病人血清心肌损伤标志物及术后心脏损伤临床指标的影响。　方法　择期全身麻醉下行心脏瓣膜置换术患者54例，将其随机分为3组，每组18例。S组（七氟烷组）和I组（异氟烷组）在麻醉诱导后至体外循环转流前分别吸入七氟烷和异氟烷进行心脏预处理：监测呼气末吸入麻醉药浓度1.3 MAC，持续30 min，并洗脱15 min。C组（对照组）吸入纯氧。3组患者麻醉维持选用芬太尼（40～45 μg/kg）和咪达唑仑，间断静脉注射维库溴铵维持肌松。3组施行相同的CPB和手术方式。观察心脏自主复跳率和复跳时间，术后室性心律失常发生情况，呼吸机辅助通气时间，术后ICU滞留时间，术后正性肌力药使用时间，种类及使用数量。并观察手术前，主动脉开放4 h、24 h、36 h的静脉血中肌酸激酶同工酶（CK-MB）和肌钙蛋白I（cTnI）的水平。　结果　3组患者住院期间均无死亡。主动脉开放后S组和I组在相同时间点的 CK-MB和cTnI的水平明显低于C组（P<0.05或P<0.01），S组的CK-MB和cTnI在相同时间点略低于I组，但差异无显著性意义；S组和I组的心脏复跳时间，低于C组（P<0.01）；S组的辅助循环时间低于I组和C组（P<0.01）。　结论　七氟烷和异氟烷一样，预处理后可减轻心肌细胞缺血引起的心肌酶释放；有利于再灌注后心功能的恢复和减少心律失常的发生，但不能说明七氟烷优于异氟烷。

Abstract:

Objective　To investigate the effects of sevoflurane preconditioning on serum myocardiac injury markers and heart injury clinical date during perioperative period in patients undergoing cardiac valve replacement with cardiopulmonary bypass.　Methods〖WTBZ〗 Fifty-four patients who had chronic heart valve disease and required cardiac valve replacement were divided randomly into three groups of eighteen persons each：sevoflurane preconditioning group(group S)，isoflurane preconditioning group(group I)，and control group(group C)．Group S and group I were pretreated with 30 min sevoflurane and isoflurane (1.3 MAC) respectively after anesthesia induction but before CPB while group C inhaled only 100% O2．The anesthesia maintain of the three group were fentanyl(40-45 μg/kg)，midazolam, and vecuronium bromide．After this the three groups carry out the same CPB and modus operandi．To observe the changes of creatinine kinase-MB isoenzyme (CK-MB) and cardiac troponin I (cTnI) at four times：before operation，4 hours, 24 hours, 36 hours after aortic unclamping and ventricular arrhythmia and other clinical data in ICU．　Results　No patients died in the duration of hospital stay. Serum cTnI，CK-MB concentrations in group S and group I were significantly lower than that in control group at the same time（P<0.05 or P<0.01）. Serum cTnI and CK-MB in group S were higher than that in group I, but no statistics differences. The clinical data in ICU in group S and group I were better than that in control group. 　Conclusion　The function of sevoflurane preconditioning is the same as isoflurane preconditioning.They can lessen release of myocardial enzyme resulting from myocardial ischemia,profit heart function recovery post-reperfusion and decrease arhythmia after preconditioning to patients. But we can not conclude that sevoflurane perconditioning is better than isoflurane preconditioning.