七氟醚预处理对体外循环冠状动脉旁路移植术病人围术期心肌的保护作用

Cardioprotective effects of sevoflurane preconditioning in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass

目的探讨七氟醚预处理对体外循环（CPB）下冠状动脉旁路移植术（CABG）病人心肌的保护作用。方法择期CPB下CABG病人40例,ASAⅡ级或Ⅲ级,随机分为2组（n=20）：七氟醚组（S组）或异丙酚组（P组）。麻醉维持：P组靶控输注异丙酚,血浆靶浓度2～3μg/L,静脉输注芬太尼2～3μg·kg^-1·h^-1；S组夹闭主动脉前,吸入0．5%～2%七氟醚,静脉输注芬太尼2～3μg·kg^-1·h^-1,夹闭主动脉后靶控输注异丙酚,血浆靶浓度2～3μg/L,静脉输注芬太尼2～3μg·kg^-1·h^-1。于切皮前即刻、CPB前即刻、CPB后即刻、回ICU后即刻、6、12h记录心率（HR）、平均动脉压（MAP）、肺动脉楔压（PCWP）、中心静脉压（CVP）、心脏指数（CI）、体循环血管阻力指数（SVRI）。于麻醉诱导前、回ICU后即刻、6、12、24h采集静脉血,测定血清心肌肌钙蛋白I（cTnI）浓度。记录术后不良事件的发生情况。结果2组各时点MAP、PCWP、CVP、HR和SVRI比较差异无统计学意义（P＞0．05）；与切皮前即刻和P组比较,S组回ICU后各时点CI升高（P＜0．05）。与P组比较,S组回ICU后各时点cTnI浓度降低（P＜0．05）。2组病人术后均无死亡；2组心肌梗塞、房颤和心肌缺血的发生率差异无统计学意义（P＞0．05）；S组cTnI浓度＞2ng/ml的发生率低于P组（P＜0．05）。结论七氟醚预处理对体外循环下冠状动脉旁路移植术病人围术期心肌具有一定的保护作用。

Objective To investigate the protective effect of sevoflurane preconditioning on myocardium in patients undergoing coronary artery bypass grafting（ CABG） under cardiopulmonary bypass（ CPB）. Methods Forty ASA Ⅱ or Ⅲ patients scheduled for CABG under CPB were randomized to 2 groups （ n = 20 ） ： sevoflurane group （group S） and propofol group （group P）. Anesthesia was maintained with propofol by target-controlled infusion （TCI） （plasma concentration 2-3 μg/L） and fentanyl infusion 2-3 μg·kg^-1·h^-1 in group P, and with inhalation of 0.5 %-2 % sevoflurane and fentanyl infusion 2-3 μg·kg^-1·h^-1 before aortic cross clamping, and TCI by propofol （plasma concentration 2-3μg/L） and fentanyl 2-3 μg·kg^-1 ·h^-1 after aortic cross clamping in group S. Heart rate （HR）, mean arterial pressure （MAP）, pulmonary capillary wedge pressure （PCWP）, central venous pressure （CVP）, cardiac index （CI）, and systemic vascular resistance index （SVRI） were recorded before the start of surgery （baseline）, before the start of CPB, after the end of CPB, at arrival in the intensive care unit（ICU） （T0）, and 6 （T6 ） and 12 （T12） hours after arrival in ICU. Blood samples were taken before the induction of anesthesia, T0, T6 , T12 , and 24 hours after arrival in ICU （ T24 ） for determination of serum concentration of cardiac troponin I （cTnI）. Postoperative cardiac events were recorded. Results The two groups were comparable with respect to MAP, PCWP, CVP, HR, and SVRI （ P 〉 0.05） ; CI was significantly increased postoperatively in group S compared with in group P and its baseline（ P 〈 0.05） . Serum cTnI concentrations were significantly lower postoperatively in group S than in group P （ P 〈 0. 05） myocardial infarction, atrial fibrillation, and myocardial There was no significant difference in the incidences of ischemia between the two groups （ P 〉 0.05）, but the incidence of serum cTnI concentration 〉 2 ng/ml was much less in group S than in group P（P 〈 0.05）. Conclusion Sevoflttrane preconditioning exerts a certain eardioprotective effect in patients undergoing CABG under CPB.