全程吸入七氟烷在体外循环手术中的应用研究

The application of sevoflurane inhalation during the whole range of cardiopulmonary bypass in open heart surgery

目的探讨体外循环转流期间经氧合器吸入七氟烷维持麻醉的可行性及优越性。方法连续78例行心脏瓣膜置换术患者随机分为七氟烷组(S组)和丙泊酚组(P组),每组39例。S组体外循环开始后经氧合器吸入七氟烷,P组靶控输注丙泊酚,监测转流期间两组脑电双频谱指数(BIS)值、平均动脉压、动脉血氧分压并测定两组麻醉前、术后8小时、术后24小时血浆心肌肌钙蛋白I浓度。结果转流期间两组BIS、平均动脉压、动脉血氧分压和混合静脉血氧分压差异无统计学意义;术后8小时、24小时血浆cTnI浓度S组明显低于P组(P<0.01)。结论体外循环转流期间经氧合器吸入七氟烷安全、可行;与丙泊酚相比,七氟烷对心肌具有一定的保护作用。

Objective This study aims to explore the feasibility and efficacy of sevoflurane inhalation via oxygenator during the whole range of cardiopulmonary bypass（CPB） on anesthesia maintenance.Methods 78 consecutive patients underwent routine heart valve replacement surgery were randomly divided into two groups,the sevoflurane group（S group） and propofol group（P group）,with 39 patients in each group.In S group,the sevoflurane was inhaled via oxygenator once the CPB was stared,while in P group propofol was injected by means of target controlled infusion.The mean blood pressure and artery oxygen partial pressure were recorded during CPB.The serum level of troponin I was also recorded preoperatively and 8 and 24 hours post operation.Results There was no significant difference between the mean blood pressure,artery oxygen partial pressure and oxygen partial pressure in mixed venous blood in each group.The serum level of troponin I in S group was significantly lower than P group at 8 and 24 hours post operation（P〈0.01）.Conclusion The sevoflurane inhalation via oxygenator during cardiopulmonary bypass is safe and feasible.Compared with propofol,sevoflurane is more effective on myocardial preservation.