异丙酚和咪唑安定对发绀型心脏病患儿心内直视手术心肌AngⅡ和HO-1的影响

Effects of propofol and midazolam on AngII and HO-1 in cardiac muscle in children with cyanotic heart disease undergoing open heart surgery

目的观察比较异丙酚和咪唑安定对发绀型心脏病患儿心内直视手术的心肌保护作用及机制。方法选择ASAⅠ～Ⅱ级行心内直视手术的发绀型心脏病患儿32例,随机分为异丙酚复合小剂量芬太尼组(PF组,n=16)和咪唑安定复合小剂量芬太尼组(MF组,n=16)。观察患儿血流动力学变化,检测开放静脉通路时(T0)、主动脉开放后2 h(T3)、术后24 h(T4)的静脉血血浆中肌钙蛋白I(cTnI)含量。检测主动脉阻断后10～20 min(T1)和主动脉开放后10～20 min(T2)时的心肌组织血管紧张素Ⅱ(AngⅡ)含量和血红素加氧酶-1(HO-1)的表达。结果 2组患儿围手术期血流动力学和同时点血cTnI水平无显著性差异;2组患儿T2时点心肌中AngⅡ含量均高于T1时点水平,T2时点心肌中AngⅡ含量PF组高于MF组(P<0.05);2组心肌HO-1表达T2时点均高于T1时点(P均<0.01),PF组同时点HO-1表达均高于MF组(P均<0.05)。结论异丙酚和咪唑安定对发绀型心脏病患儿体外循环心内直视手术心肌保护作用相当,咪唑安定抑制心肌AngⅡ表达的作用比异丙酚强,而异丙酚刺激心肌HO-1表达的作用优于咪唑安定。

Objective It is to observe and compare the cardio-protective effects and underlying mechanisms of propofol and midazolam in children with cyanotic heart disease undergoing open heart surgery.Methods 32 ASA class Ⅰ～Ⅱ children with cyanotic congenital heart disease undergoing open heart surgery were randomly divided into two groups： propofol combined with low dose fentanyl group（group PF,n=16）and midazolam combined with low dose of fentanyl group（group MF,n=16）.The changes of hemodynamics were observed.Blood samples were taken when open venous channel（T0）,at 2h after releasing of aorta cross-clamp（T4） and at 24h after operation（T5） to detect the change of blood cardiac Troponin I（cTnI）.Myocardium samples were collected at 10-20min after aorta cross-clamp（T2）and at 10-20min after releasing of aorta cross-clamp（T3） to detect angiotensin Ⅱ（AngⅡ） level and heme oxygenase-1（HO-1） expression in myocardium.Results The changes of hemodynamics perioperatively and plasma cTnI at the same time were similar between the two groups（P〉0.05）.The myocardial AngII level at T3 was higher than that at T2 in both groups,and the AngII level at T3 in group PF was higher than that in group MF（P〈0.05）.The expression of HO-1 at T2 was significantly higher than that at T1 in both groups（P〈0.01）,and the HO-1 expression in group MF was significantly lower than that in group PF at all the corresponding time points（P〈0.05）.Conclusion The cardio-protective effects were similar between propofol and midazolam in children with cyanotic heart disease undergoing open heart surgery.Midazolam is superior to propofol in inbibiting the expression of AngII,but propofol is superior to midazolam in stimulating the expression of HO-1.