依托咪酯与咪达唑仑防治儿童紫绀型心脏病心内直视手术心肌损伤作用比较

Comparision of the Cardioprotective Effects of Etominate and Midazolam in Children with Cyanotic Heart Disease Undergoing Open Heart Surgery

目的比较依托咪酯与咪达唑仑对儿童紫绀型心脏病心内直视手术时心肌损伤的防治作用。方法选择NYHA心功能I-Ⅱ级行心内直视手术的紫绀型心脏病儿童患者36例,随机等分为两组:依托咪酯复合小剂量芬太尼组(EF组)和咪达唑仑复合小剂量芬太尼组(MF组)。观察患者围术期血流动力学、脉搏血氧饱和度和体温变化,记录术后拔管时间和ICU停留时间。检测开放静脉通路时(t0)、麻醉诱导后10min(t1)、主动脉阻断后20min(t2)、主动脉开放后20min(t3)、主动脉开放后2h(t4)和术后24h(t5)静脉血浆中Ang-Ⅱ(AngⅡ)的含量;检测t2和t3时心肌组织中AngⅡ含量,并观察心肌血红素加氧酶-1(HO-1)的表达;检测t0、t4、t5的静脉血浆中肌钙蛋白I(cTnI)含量。结果EF组患者术后拔管时间和ICU停留时间较MF组患者短(P<0.05);两组患者t3时点心肌中Ang-Ⅱ含量均高于t2时点水平,而且EF组t3时点心肌中Ang-Ⅱ含量高于MF组(P<0.05);两组患者t4时点cTnI的水平均高于t0和t5时点(均P<0.01),t5时点cTnI的水平高于t0时点(P<0.01);两组患者心肌HO-1灰度值t2时点均高于t3时点(均P<0.01),EF组t2、t3时点HO-1灰度值均低于MF组同时点值(均P<0.05)。结论依托咪酯与咪达唑仑对儿童紫绀型心脏病心内直视手术时心肌均有保护作用,咪达唑仑抑制心肌AngⅡ表达的作用比依托咪酯强,而依托咪酯刺激心肌HO-1表达的作用优于咪达唑仑,且依托咪酯更利于患者的术后恢复。

Objective To compare the cardioprotective effects of etominate and midazolam in children with cyanotic heart disease undergoing open heart surgery. Methods Thirty-six children with cyanotic heart disease in NYHA class Ⅰ-Ⅱ were randomly divided into two groups： etominate combined with low dose of fentanyl（ Group EF, n = 18 ） and midazolam combined with low dose of fentanyl （ Group MF, n = 18 ）. The changes of heamodynamics, SpO2, nasopharyngeal and rectal temperature were continuously monitored ; the time of tracheal extubation and staying in ICU were recorded. Blood samples were collected to detect the change of plasma angiotensin Ⅱ（AngⅡ） at the following time points ： intravenous catheter （ t0 ）, 0 min after anesthesia induction （t2 ）, 20 min after aorta cross-clamp （t2 ）, 20 min after releasing of aorta cross-clamp （t3 ）, 2 hours after releasing of aorta cross-clamp（t4 ） , and 24 hours after operation （t5 ）. Myocardium samples were collected to measure the change of AngⅡ and observe the expression of hemeoxygenase-1 （ HO-1 ） at t2 and t3 respectively. And the change of plasma cardiac troponin Ⅰ （cTnⅠ） was observed at the following time points ： t0, t4, t5. Results The time of tracheal extubation and staying in ICU in group EF were significantly shorter than those in group MF （ P 〈 0.05 ）. The concentration of myocardium AngⅡ at t3 was higher than that in both groups at t2, and which in group EF at t3 was higher than that in group MF at the same time point （P 〈 0.05）. In both groups, the level of plasma cTnⅠ at t5 was significantly higher than that at t0 or t5 （P 〈0.01 ） ,and which at t5 was higher than that at t0 （P 〈 0.01 ）. The expression of HO-1 at t2 was significantly lower than that at t3 in both groups, respectively （P 〈 0.01 ）, and the expression of HO-1 at t3 or t4 in group EF was significantly lower than that in group MF at the corresponding time point （P 〈 0.05）. Conclusion Both etominate and midazolam have cardioprotective effects for children with cyanotic heart disease undergoing open heart surgery. Midazolam is superior to etominate in inhibiting the expression of AngⅡ, while etominate is better than midazolam in stimulating the expression of HO-1 and shortening postoperative recovery time.