丙泊酚后处理对体外循环冠脉旁路移植术患者心肌缺血再灌注损伤的影响

Effect of Propofol Postconditioning on Myocardial Ischemia/Reperfusion Injury in Patients Undergoing Coronary Artery Bypass Grafting with Cardiopulmonary Bypass

目的:探讨主动脉开放即刻靶控输注丙泊酚1mg/L对体外循环下行冠状动脉旁路移植术患者心肌缺血再灌注损伤的影响。方法:择期体外循环下行冠状动脉旁路移植术患者40例,ASAⅡ级或Ⅲ级,随机分为七氟烷组(S组)和丙泊酚后处理组(P组)各20例。S组全程吸入0.5%～2%七氟烷;P组在主动脉开放前持续吸入0.5%～2%七氟烷,主动脉开放即刻靶控输注丙泊酚,血浆靶浓度为1mg/L,同时下调七氟烷吸入浓度,维持脑电双频谱指数(BIS)值在40～60范围直至手术结束。于麻醉诱导前即刻(T0)、主动脉开放后10min(T1)、回重症监护病房(ICU)后即刻(T2)、6h(T3)、12h(T4)、24h(T5)取桡动脉血测定心肌肌钙蛋白(IcTnI)、肌酸激酶同工酶(CK-MB)、可溶性细胞间黏附分子-1(sICAM-1)和CD11b水平。结果:2组不同时点cTnI、CK-MB、sICAM-1和CD11b浓度差异具有统计学意义(P<0.05);与S组比较,P组cTnI和CK-MB浓度在T3～5时降低、sICAM-1浓度在T2～5时降低、CD11b表达在T1～5时降低;2组术后心肌梗死、房颤和心肌缺血的发生率差异无统计学意义(P>0.05)。结论:体外循环下行冠状动脉旁路移植术患者于主动脉开放即刻靶控输注丙泊酚1mg/L可减轻心肌缺血再灌注损伤,具有后处理保护作用。

Objective：To investigate the effect of target controlled infusion of propofol 1 mg/L from the end of aortic artery occlusion on myocardial ischemia/reperfusion injury in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. Methods：Forty ASA Ⅱ or Ⅲ patients undergoing elective coronary artery bypass grafting with cardiopulmonary bypass were randomly divided into sevoflurane group （group S） and propofol postconditioning group （group P）,each has 20 cases. Group S maintained with sevoflurane 0.5%～2% during the whole period of operation. Group P inspirited sevoflurane 0.5%～2% from the beginning of anesthesia,then received target controlled infusion of propofol 1 mg/L from the end of aortic artery occlusion,and modulated the inspiratory concentration of sevoflurane to maintain the bispectral index （BIS） value at 40 to 60 range. The concentrations of cardiac troponin I （cTnI）,creatine kinase （CK-MB）,soluble intercellular adhesion molecule-1 （sICAM-1） and expression of CD11b were determined before the induction of anesthesia（T0）,10 min after the end of aortic artery occlusion （T1）,at arrival in the intensive care unit （T2）,6,12 and 24 h after arrival in the intensive care unit （T3,T4,T5）. Results：There were significant differences in concentrations of cTnI,CK-MB,sICAM-1 and CD11b at different time points between the two groups （P〈 0.05）. As compared with group S,the concentrations of cTnI and CK-MB were significantly decreased at T3～5,the concentration of sICAM-1 was lower at T2～5,and the expression of CD11b was significantly decreased during T1～5 in group P. There was no significant difference in the incidence of myocardial infarction,atrial fibrillation and myocardial ischemia between the two groups （P〉 0.05）. Conclusion：Target controlled infusion of propofol 1 mg/L from the end of aortic artery occlusion provided myocardial protection to ischemia/reperfusion injury in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.