摘要
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.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2007年第5期427-430,共4页
Chinese Journal of Anesthesiology
基金
基金项目:浙江省卫生厅科研项目(2006B052)
关键词
缺血预处理
心肺转流术
心肌
炎症
七氟烷
Ischemic preconditioning
Cardiopulmonary bypass
Myocardium
Inflammation
Sevoflurane