七氟醚后处理对瓣膜置换术中血清肌钙蛋白T及IL-6、IL-8浓度的影响

The effect of sevoflurane postconditioning on serum concentration of troponin T and IL-6,IL-8 in adult patients with rheumatoid heart disease during valve replacement surgery

目的观察七氟醚后处理对瓣膜置换术中血清心肌损伤标志物肌钙蛋白T(cTnT)及白细胞介素(IL)-6、IL-8浓度的影响,探讨其心肌保护作用。方法 24例拟行单瓣膜置换术的风湿性心脏病患者,随机均分为七氟醚组(S组)和对照组(C组)。两组采用相同麻醉及体外循环方法。S组在主动脉开放后即刻吸入5%七氟醚,呼气末浓度达1MAC后调整吸入浓度并维持1MAC10min,C组不吸入七氟醚。麻醉后即刻(T1)和主动脉开放后1h(T2)、2h(T3)、4h(T4)经桡动脉采血3ml,分别用电化学发光法和放射免疫法测定血清cTnT和IL-6、IL-8浓度。结果两组T2～T4时血清cTnT、IL-6、IL-8浓度均明显高于T1时,但S组明显低于C组(P<0.05)。结论七氟醚后处理能明显减轻瓣膜置换术中心肌缺血-再灌注损伤,其机制可能与抑制全身炎症反应有关。

Objective To investigate the effect of sevoflurane postconditioning on serum concentrations of troponin-T（cTnT）, IL-6, IL-78 for exploring its myocardial protection mechanism in patients with rheumatoid heart disease during valve replacement under cardiopulmonary bypass （CPB）. Methods Twenty four adult patients scheduled for valve replacement surgery under CPB were enrolled and divided randomly into sevoflurane postconditioning group （group S） and control group （group C）. In group S, 1.0 MAC end-expiratory concentration of sevoflurane was reached and maintained for 10 min after aorta declamping and release of vena cava, and in group C without sevoflurane. 3 ml of blood samples were collected at four time points, i.e. Tl （baseline） ：immediately after anesthesia induction; and 1 h, 2 h, 4 h after aorta declamping （T2, T3 , T4 ）. The cTnT, IL-6 and IL-8 were measured respectively by electrochemiluminescence or radio-immunity. Results Comparing with T1, cTnT, IL-6 and IL-8 increased markedly at T2-T4 in both groups （P〈0.05）. However, serum level of cTnT, IL-6 and IL-8 were significantly lower at T2-T4 in group S than in group C （P〈0.05）. Conclusion Sevoflurane postconditioning can remarkably lessen myocardial ischemia reperfusion injury in patients with rheumatoid heart disease during valve replacement surgery probablely by attenuation of systemic inflammatory response.