丙泊酚和依托咪酯对心脏瓣膜置换术患者肌钙蛋白I和超敏C反应蛋白的影响

Effects of propofol and etomidate on cardiac troponin I (cTnI) and hypersensitive C-reactive protein (hsCRP) in patients undergoing cardiac valve replacement

目的比较等效剂量丙泊酚和依托咪酯乳剂对心肺转流(CPB)心脏瓣膜置换术患者血清心肌肌钙蛋白I(cTnI)和超敏C反应蛋白(hsCRP)的影响。方法择期心脏瓣膜置换术患者60例,随机均分为两组:丙泊酚组(P组)术中静脉持续输注丙泊酚3～5mg·kg-1·h-1,依托咪酯乳剂组(E组)持续输注依托咪酯0.3～0.6mg·kg-1·h-1维持麻醉。分别于麻醉诱导前(T0)、CPB前(T1)、主动脉开放即刻(T2)、主动脉开放后30min(T3)、停CPB后4h(T4)、24h(T5)采取静脉血,测定血清cTnI和血浆hsCRP浓度。结果与T0时比较,T2～T5时两组血清cTnI浓度均显著升高(P<0.01),且E组显著高于P组(P<0.01);T1～T5时E组血浆hsCRP浓度显著升高(P<0.01),且明显高于P组(P<0.01),而P组仅在T4、T5时显著升高(P<0.01)。结论等效剂量丙泊酚用于CPB心脏瓣膜置换术麻醉维持的心肌保护作用优于依托咪酯乳剂。

Objective To compare the effects of propofol and etomidate on serum troponin I （cTnI） and hyper-sensitive C-reactive protein （hsCRP） in patients undergoing cardiopulmonary bypass （CPB） for cardiac valve replacement. Methods Sixty patients undergoing cardiac valve replacement were randomly divided into two groups. Anesthesia was maintained with continuous infusion of propofol 5 mg.kg-1 .h-1 in group P or etomidate 0. 6 mg.kg-1 .h-1 in group E. Venous blood samples were taken before anesthesia induction （T0）, before CPB （T1）, right after declamping aorta （T2）, 30 rain after declamping aorta （Ta）, 4 h （T4） and 24 h （Ts） after cessation of CPB for determining serum cTnI and hsCRP. Results cTnI was increased after declamping aorta in both groups （P〈0. 01）, and eTnI from T2 to Ts in group E was significantly higher than that of group P （P〈0. 01）. Group E of hsCRP was increased from T1 to Ts （P〈0. 01） and was significantly higher than that of group P （P〈0. 01）, while hsCRP in group P was only increased at T4 and T5 （P〈0. 01）. Conclusion Equivalent dose of propofol is superior to etomidate for myocardial protection during cardiopulmonary bypass for cardiac valve replacement.