七氟醚后处理对心脏瓣膜置换术患者心肌酶的影响

Sevoflurane postconditioning effects on myocardial enzyme for patients with cardiac valve replacement surgery

目的：探讨体外循环下七氟醚后处理对心脏瓣膜置换术患者心肌酶的影响。方法：30例体外循环下行心脏瓣膜置换术患者,女19例,男11例,体重40~70 kg,年龄25~65岁,ASA分级Ⅱ~Ⅲ级,随机分为对照组（C组）与七氟醚后处理组（S组）,每组15例。S组经体外循环于主动脉开放时以2%七氟醚灌入血液循环15 m in,C组不作以上处理,采用全凭静脉麻醉。分别于手术开始时（T1）、主动脉开放后0.5 h（T2）、主动脉开放后3 h（T3）、主动脉开放后24 h（T4）4个时点采集中心静脉血,提取上清置于EP管-20℃保存。检测血清乳酸脱氢酶（LDH）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、心肌肌钙蛋白（cTnI）浓度,并记录两组患者血流动力学、体外循环时间、主动脉阻断时间、手术时间和术后使用多巴胺的总量。所有数据均作统计学分析。结果：两组患者围术期血流动力学指标均保持稳定。两组患者血清LDH、CK、CK-MB、cTnI水平均较术前显著升高（P〈0.05）;与C组相比,S组LDH在T4时明显降低（P〈0.05）,cTnI和CK在T3、T4时间点也明显降低（P〈0.05）,CK-MB在T2时点明显降低（P〈0.05）。结论：体外循环七氟醚后处理可以降低心脏瓣膜置换术患者心肌酶的释放,减轻心肌缺血再灌注损伤。

Objective： To evaluate the effects of sevoflurane postconditioning on myocardial enzyme leasing for cardiac valve replacement patients.Methods： Thirty patients scheduled for cardiac valve replacement surgery under cardiopulmonary bypass,with 19 female,11 male,weights ranged from 42-70 kg,aged 24-64 years,ASA gradeⅡ-Ⅲ,were randomly divided into 2 groups（n=15）： control group（group C） and sevoflurane postconditioning group（group S）.In group S,the 2% sevoflurane was irrigated into blood circulation by cardiopulmonary bypass for 15 minutes when aorta opened instantly,patients in group C didn＇t receive the treatment above,with intravenous anesthesia only.The central vein blood was collected at the beginning of the operation（T1）,0.5 h after aorta opening（T2）,3 h after aorta opening（T3）,and 24 h after aorta opening（T4）,the supernatant fluid was saved into EP tube in-20 ℃.The plasma lactate dehydrogenase（LDH）,creatine kinase（CK）,creatine kinase isoenzyme（CK-MB）,and cardiac troponin I（cTnI） blood concentration was meaured at T1,T2,T3,T4.The hemodynamics,time of cardiopulmonary bypass,time of aorta block,time of operation,and total dopamine dosage were recored in the two groups.All data were analyzed by statistical method.Results：The perioperative hemodynamics of two groups was stable.The LDH,CK,CK-MB,cTnI levels of both groups were higher than beginning of the operation（P〈0.05）.Compared with the group C,LDH in group S was lower at T4（P〈0.05）;cTnI and CK at T3,T4 decreased（P〈0.05）;CK-MB at T2 was lower（P〈0.05）.Conclusion： Sevoflurane postconditioning by cardiopulmonary bypass can reduce the release of enzymes for patients with heart valve replacement surgery,thus decrease myocardial ischemia-reperfusion injury.