七氟烷预处理对体外循环患者炎性反应的影响

Effect of sevoflurane preconditioning on inflammatory response in patients undergoing cardiac surgery with cardiopulmonary bypass

目的 观察七氟烷预处理对体外循环（GPB）患者炎性反应的影响，探讨其心肌保护作用机制。方法 30例择期CPB下心内直视手术患者，随机分成2组（n=15）：对照组（C组）和七氟烷预处理组（S组）。S组手术开始至CPB前吸入七氟烷（呼气末浓度2％）20min，随后给以10min洗脱期，而C组患者只吸入纯氧。分别于麻醉诱导前即刻（T0）、主动脉开放后10 min（T1）、CPB后即刻（T2）、4h（T2）、24h（T4）采集桡动脉血，测定血浆肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-6、IL-8、细胞粘附分子（ICAM）-1、肌酸激酶同工酶（CK-MB）及心肌肌钙蛋白I（cTnⅠ）水平，并观察主动脉开放后心脏自主复跳情况。结果 与T0时比较，2组T1-4时TNE-α、ICAM-1、IL-6、IL-8、CK-MB及cTnⅠ水平均升高（P〈0．01）;与C组比较，S组T1-4时TNT-α、IL-6、IL-8浓度均降低，T2-4时ICAM-1、CK-MB、cTnⅠ水平均降低，心脏自主复跳率较高（P〈0．05或0．01）。结论 七氟烷预处理（吸入2％七氟醚2 h）通过抑制炎性反应，对CPB患者心肌产生一定的保护作用。

Objective To investigate the effect of sevoflurane preconditioning on plasma TNF-α, IL-6, IL-8 and ICAM-1 levels in patients undergoing cardiac surgery with cardiopulmonary bypass （CPB） . Methods Thirty ASA Ⅰ or Ⅱ patients （ 13 male, 17 female） aged 18-56 yr weighing 41-67 kg were randomly allocated to one of two groups （ n = 15 each） ： Ⅰ control group （C） and Ⅱ sevoflurane preconditioning group （S）. In group S 2% sevoflurane was inhaled for 20 min starting from skin incision while in group C the patients inhaled only 100% O2 . Blood samples were obtained from radial artery before induction of anesthesia （T0, baseline）, 10 min after aortic unclamping （T1）, at the discontinuation of CPB （T2）, 4 h （T3 ） and 24 h （T4） after CPB for determination of plasma levels of TNF-α, IL-6, IL-8. ICAM-1, CK-MB and cTnⅠ. Spontaneous recovery of normal heart beat after release of aortic cross clamp was recorded. Results Plasma levels of TNF-α, IL-6, IL-8, ICAM-1, CK-MB and cTnⅠ were significantly increased at T1-4 as compared with the baseline values at TO in both groups and were significantly lower in group S than in group C（P 〈 0.05 or 0.01）. The percentage of spontaneous recovery of normal heart beat after release of aortic cross clamp was significantly higher in group S than in group C. Conclusion Sevoflurane preconditioning can effectively inhibit the inflammatory response in patients undergoing open heart operation with CPB.