异丙酚、异氟醚及其联合应用在冠脉搭桥术中对心肌的保护作用

Protective effects of propofol, isoflurane and their combination on myocardium for patients undergoing coronary artery bypass graft

目的 :通过动态观察心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶 (CK MB)、超氧化物歧化酶 (SOD)和丙二醛 (MDA)的变化 ,比较麻醉剂异丙酚、异氟醚以及它们联合用药在心内直视手术中对心肌保护的影响。方法 :将 6 0例择期行冠脉搭桥术患者随机分为对照组、异丙酚组、异氟醚组和联合用药组。麻醉诱导和维持异丙酚组用异丙酚等 ,异氟醚组用异氟醚等 ,联合用药组异丙酚复合异氟醚等。分别于麻醉后转流前 (T0 )、开放升主动脉后 30min(T1)以及停机后 4h(T2 )、2 4h(T3 )、4 8h(T4)测定血浆cTnI、CK MB、SOD、MDA浓度。结果 :各组患者血浆cTnI、CK MB及MDA自T1均不同程度升高 ,异丙酚组、异氟醚和联合用药组cTnI及MDA值分别于T2 、T3 时显著低于对照组 ,联合用药组血浆cTnI于T3 时显著低于异丙酚组 (P <0 .0 5 ) ,联合用药组的心脏自动复跳率显著高于其它各组 (P <0 .0 5 )。结论 :在冠脉搭桥术中 ,麻醉剂异丙酚、异氟醚的应用均在一定程度上减轻由脂质过氧化反应介导的心肌缺血再灌注损伤 ,尤以异丙酚。

AIM: To observe the cardioprotective effects of propofol, isoflurane and their combination by comparing changes of plasma concentrations of cTnI, CK-MB, SOD and MDA during open heart surgery. METHODS: Sixty patients, scheduled for elective coronary artery bypass graft, were randomly divided into control, propofol, isoflurane and their combined use groups, respectively. In Group propofol, isoflurane or combined use groups, propofol, isoflurane or propofol combined with isoflurane were given respectively. The venous blood samples were taken to measure plasma concentrations of cTnI, CK-MB, SOD and MDA before CPB beginning (T 0), and 30 min after release of aortic cross-clamp (T 1), 4 h (T 2), 24 h(T 3), and 48 h(T 4) after CPB stop. RESULTS: The plasma concentrations of cTnI, CK-MB and MDA in all patients after T 1 increased in different extent, the plasma concentrations of cTnI and MDA in group propofol, isoflurane and combined use groups at T 2 and T 3 were much lower than those of group control, the plasma concentration of cTnI in group M at T 3 was much lower than that in group propofol(P< 0.05), and the rate of heart automatic beating after release of aortic cross-clamp in combined use groups was much higher than those in the other groups(P< 0.05). CONCLUSION: Anesthetic uses of propofol and isoflurane, specially combined use, can reduce myocardial ischemia-reperfusion injury induced by oxygen free radical in patients undergoing coronary artery bypass graft.