吗啡复合七氟醚预处理对体外循环冠脉搭桥患者术中的心肌保护作用

Myocardial protective effects of pretreatment with morphine and sevoflurane during coronary-artery bypass surgery

目的探讨吗啡复合七氟醚(S)预处理对体外循环(CPB)冠脉搭桥手术患者术中心肌损伤的影响。方法将择期行CPB冠状动脉搭桥术患者随机分成对照组、S预处理组、吗啡复合S(MS)预处理组,分别检测各组术中和术后24h内不同时相点的血肌钙蛋白Ⅰ(cTnⅠ)浓度和肌酸激酶同工酶(CK-MB)活性变化,以及心率、平均动脉压、中心静脉压、心排出量等血流动力学指标的变化。结果各组患者之间的性别、年龄、体质量、ASA分级、术前射血分数和搭桥的冠状动脉数均无显著差异,麻醉时间、CPB转流时间、外科手术时间等也均无显著差异。MS预处理组心输出量在CPB结束和手术结束时较对照组明显升高,两组差异有统计学意义(P<0.05)。MS预处理能显著降低血中cTnⅠ的释放,与对照组相比差异有统计学意义(P<0.01);MS预处理组的CK-MB活性也明显低于对照组(P<0.05)。结论在CPB冠脉搭桥手术中,采用MS预处理能显著减少术中的心肌损伤,改善转流后心肌功能的恢复。

Objective To explore the effects of pretreatment with morphine and sevoflurane on myocardiac injury during coro nary-artery bypass surgery. Methods Thirty patients scheduled for coronary-artery bypass surgery were randomly assigned to control group（n= 10）, sevoflurane（S） preconditioning group（n = 10）, morphine and sevoflurane （MS） preconditioning group（n = 10）. Blood samples were taken for the measurement of cTn I and CK-MB before anesthesia induction, skin incision, the end of eardiopulmonary bypass（CPB）, 6h and 24h after surgery. Hemodynamie indexes such as heart rate, mean arterial pressure, central venous pressure and cardiac output were recorded at four time points （skin ineision,5min pre-CPB,at the end of CPB or surgery）. Results There was no difference in the patient＇s data among the three groups,including gender, age, body weight, ASA grade, ejection fraction before surgery, duration of anesthesia,CPB and surgery. The cardiac output in MS preconditioning group was much higher than that in control group at the end of both CPB and surgery（P〈0.05）. After CPB,the level of plasma cTn I was much higher in control group than that in MS preconditioning group（P〈0. 01）. In all patients, the activity of CK-MB increased significantly after CPB,whieh was much lower in MS preconditioning group than in control group（P〈0.05）. Conclusion Morphine and sevoflurane preconditioning protects against myocardium injury during open heart surgery under cardiopulmonary bypass and improves cardiac function after CPB.