依托咪酯、咪唑安定、丙泊酚对心内直视手术病人心肌酶的影响

Effects of Etomidate and Midazolum and Propofol on myocardial enzymes in patient undergoing open heart surgery

目的 比较依托咪酯(E)、咪唑安定(M)、丙泊酚(P)对心内直视手术心肌缺血再灌注损伤的保护作用。方法 30例心内直视手术病人,在相同术前药、相似麻醉诱导、维持方案下,变更使用的麻醉镇静药E、M、P。随机分成3组,分别在诱导后、主动脉开放后30min、4h、16h、24h 5个时点测定血清中心肌酶AST(天冬氨酸转氨酶)、LDH(乳酸脱氢酶)、α-HBD(α-羟丁酸脱氢酶)、CK(肌酸磷酸激酶)、CK-MB(肌酸磷酸激酶同工酶)的浓度。结果心肌缺血再灌注后各心肌酶指标均有明显升高,CPK、CK-MB尤为明显,在24h后开始回落,E组的升高幅度明显高M和P组。结论 M和P能降低心肌酶的上升幅度。提示对心肌再灌注损伤比E有较大作用。

Objective To compare the protective effect of Etomidate(E)and Midazolun(M)and Propofol (P)on myocardial isehemia reper-fusion injury undergoing open heart surgery. Methods 30 patients of undergoing open heart surgery were divided into three groups,with same premeditation and similar anesthesia induction and maintenance of anesthesia,that the drugs of sedative anesthesia were changed. The blood samples were taken to measured the concentration of myocardial enzymes:aspartate amino transferase(AST)、laetate dehydrogenase(LDH),α-hydroxy-butyric dehydrogenase (α-HBD),creatine kinase (CK),creatine kinase isoenzyme (CK-MB),at five timepoint on following induction,after release of the aortic crossclamp 30 min、4h、16h、24h. Results After myocardial ischemia-reperfusion injury,the concentration of serum myocardial enzymes was all significantly higher, specially CK and CK-MB,but after 24h began fall after rise. Conclusion M and P can decrease the amplitude of rise of myocadial enzyme,and have more effects then E on the myocardial reperfusion injury.