瑞芬太尼预处理对急性失血性休克家兔心肌肌钙蛋白Ⅰ及心率的影响

Influence of Remifentanil Pretreatment on Cardiac TroponinⅠ and Heart Rate in Acute Hemorrhagic Shock in Rabbits

目的观察瑞芬太尼预处理对急性失血性休克家兔心肌肌钙蛋白I及心率的影响。方法24只家兔随机均分为三组:生理盐水对照组(C组,n=8)、低剂量瑞芬太尼组(R1组,n=8)、高剂量瑞芬太尼组(R2组,n=8)。按照Wigger's改良法制作家兔急性失血性休克模型。R1组、R2组分别于放血前15min开始持续泵入瑞芬太尼0.66μg.kg-1.min-1或1.32μg.kg-1.min-1;C组持续泵入等容量生理盐水。放血使平均动脉压(MAP)降至约40mmHg。持续监测心率(HR)、MAP。各组分别在放血前(T1)、放血后10(T2)、40(T3)、70(T4)、100(T5)、130(T6)min抽血测定血清心肌肌钙蛋白I(cTnI)浓度。结果与基础心率T0比较,休克期间,各组心率随着时间的推移,逐渐下降(P<0.05);与C组比较,R2组心率下降(P<0.05)。与T1时比较,T4、T5、T6时各组的cTnI浓度均升高(P<0.05),R2组T3时cTnI浓度已高于T1(P<0.05)。R1组和R2组cTnI浓度均明显低于C组(P<0.05)。R2组T5、T6时的cTnI浓度均低于R1组(P<0.05)。结论瑞芬太尼可剂量依赖性地使急性失血性休克家兔心率减慢,血清cTnI浓度降低,此效应可能与其心肌保护作用有关。

Objective To observe the effect of remifentanil pretreatment on cardiac troponin Ⅰ in Hemorrhagic Shock in Rabbits.Methods 24 healthy rabbits were randomly divided into three groups： control group NS（group C n=8）,Low-dose remifentanil group（R1 group,n= 8） and High-dose remifentanil group（R2 group,n=8）.The model of acute hemorrhagic shock was established by modified Wigger＇s methods.In R1 group remifentanil 0.66μg·kg^-1·min^-1 was pumped 15 minutes before blooding and in R2 group remifentanil 1.32μg·kg^-1·min^-1was pumped 15 minutes before blooding,in group C same volume of normal saline was pumped.Blood was removed from femoral artery and MAP was maintained at 40mmHg.Mean arterial blood pressure（MAP）,heart rate（HR） were measured and serum troponin Ⅰ（CTnⅠ） was determined at the following time,immediately before bloodletting（T1）,（T2）10 min after bloodletting and（T3）40,（T4）70,（T5）100,（T6）130min after bloodletting.Results compared with T0（basic heart rate）,Heart rate in each group gradually decreased with time（P〈0.05）.Heart rate in groups R2 were significantly lower than those in groups C.cTnⅠ Concentration in all group were significantly higher at the point of T4、T5、T6 than those at T1（P〈0.05）.Levels of cTnⅠ in R2 group at T3 higher than those at T1（P〈0.05）,but in group R1 and R2 they were lower than those in group C（P〈0.05）.cTnI Concentration at the point of T5 、T6 in group R2 were lower than those in group R1（P〈0.05）.Conclusion In rabbits with acute hemorrhagic shock,remifentanil slowed the rabbit heart rate in a concentration-dependent manner.as time goes on,the degree of shock became more serious,concentration of cTnⅠ was increasing,but high-dose remifentanil could decrease cTnI condentration.