芬太尼延迟性预处理对体外循环下心脏瓣膜置换术的心肌保护作用

Cardioprotective effects of fentanyl delayed pretreatment on patients undergoing heart valve replacement surgery

目的:观察术前给予芬太尼对全麻体外循环下行心脏瓣膜置换术患者心肌的保护作用。方法:择期在全麻体外循环下行心脏瓣膜置换术患者共60例,心功能Ⅱ～Ⅲ级(NYHA标准)。随机被分为芬太尼预处理组和对照组:芬太尼预处理组术前2d给予0.3μg/kg.h芬太尼泵微量持续注射,分别在术前,主动脉开放1h、6h、12h、24h、48h采集血标本,测定肌钙蛋白I(cTnI)水平;并记录术中体外循环时间、主动脉阻闭时间、停跳液量、复跳方式、ICU停留时间等指标以及计算在ICU停留期间正性肌力药物得分。结果:芬太尼组血清cTnI整体升高水平低于对照组,其中在主动脉钳夹开放后6h、12h、24h与对照组相比有显著差异(P均<0.05);芬太尼组在ICU停留的时间显著少于对照组(P<0.05);在进入ICU后12h、24h、48h的正性肌力药物使用得分显著低于对照组(P均<0.05)。结论:术前给予阿片受体激动剂芬太尼的延迟预处理对全麻体外循环下行心脏瓣膜置换术的患者具有心肌保护作用。

Objective：To study the protective effects of fentanyl delayed pretreatment on myocardial injury in patients undergoing heart valve replacement surgery.Methods：Sixty patients diagnosed with acquired heart valve diseases were randomly allocated to the fentanyl delayed pretreatment group（fentanyl group） or control group （n=30 each group）.The detailed experimental protocols are as following：The pretreatment given fentanyl（0.3μg/kg·h continual intravenous injection by infusion pump） individualizedly based on patients sex,age,weight and felt before the heart valve replacement surgery.Anesthesia,cardiopulmonary bypass and surgery were performed as well between two groups.Results：The level of serum cTnI in fentanyl group was significant lower than that in control group,at the time points of 6h,12h and 24h after reperfusion,levels of serum cTnI were significantly decreased in the fentanyl group（P〈0.05 all）.Length of ICU stay of fentanyl group was shorter than that of control group（P〈0.05）.The cardiotonic agent scores of fentanyl group were lower than those in control group at 12h,24h and 48h after ICU arrival （P〈0.05 all）.Conclusion：This study results showed that pretreatment fentanyl inhibited the elevation of troponin-I,reduced the cardiotonic agent use,and shortened the ICU stay time in the postoperative period of heart valve replacement surgery,suggesting a potential myocardial protective effect of pretreatment with fentanyl or opioid-peptide.