持续或间断七氟醚后处理对婴幼儿心肌缺血再灌注损伤的作用

The effect of interrupted or continuous administration of sevoflurane on infants undergoing ventricular septal defect repair with cardiopulmonary bypass

目的比较先天性室间隔缺损患儿在体外循环下行修补术时,持续或间断七氟醚后处理对其心肌缺血再灌注损伤的保护作用。方法选择36例室间隔缺损行心内直视手术的患儿,随机分为3组。持续后处理组:在主动脉开放的即刻,吸入1.0最低肺泡有效浓度(MAC)的七氟醚,持续30 min;间断后处理组:在主动脉开放的即刻起,间断吸入1.0 MAC的七氟醚,每次2 min;对照组:不吸入七氟醚。记录各组患儿的主动脉阻断时间、体外循环(CPB)时间以及手术时间,记录患儿入住重症监护室(ICU)后的呼吸机支持时间、ICU滞留时间以及住院时间。麻醉诱导后,体外循环结束时,体外循环后12、24、48 h,采集动脉血,测定血浆肌钙蛋白-I(cTnI)、肌红蛋白(Mb)、肌酸激酶同工酶-MB质量(CK-MB mass),并进行比较。结果持续后处理组和间断后处理组患儿体外循环后24 h的cTnI和CK-MB均低于对照组,且间断后处理组比持续后处理组更低,差异均有统计学意义(P<0.01)。结论吸入七氟醚后处理可使患儿心肌损伤程度有所减轻,且间断后处理更有利于减轻患儿心肌损伤。

Objective The present study was designed to compare the protective effect of interrupted administration with continuous administration on myocardial ischemia and reperfusion injury of infants undergoing ventricular septal de fect （VSD） repair with cardiopulmonary bypass （CPB）. Methods 36 children scheduled for VSD repair with CPB un der general anesthesia were randomly divided into three groups. In group I , the control group, the patients did not re- ceive any inhalation anesthetics during the surgery. In group Ⅱ, 1.0 MAC sevoflurane was eontinuausly administered for 30 min in postconditioning afteraortic cross unclamping. In group Ⅲ, 1.0 MAC sevoflurane was interrupted administerde for 2 min every time in postconditioning afteraortic cross unclamping. Aortic cross-clamping time, CBP time and operation time of infants in each group were recorded. Ventilator support time in intensive care （ICU） , ICU retention time and the length of hospital stay were also recorded. For detection of troponin I （cTn-I）, myoglobin and creatine kinase MB mass blood samples were obtained at 5 min after induction （To） , the end of CPB （T1） , 12 h after CPB （T2）, 24 h after CPB （T3） and 48 hailer CPB （T4）. Results Plasma levels of cTn-I and CK-MB were significantly lower in grouplI and Ⅲat 24 h after CPB （T3） than those in control group, and furthermore cTnI and CK-MB levels in group m at T3 were significantly lower than those in group Ⅱ（P 〈 0.01）. Conclusions Both interrupted and continuous adminis- tration of sevoflurane in postconditioning showed cardioprotective effects on myocardial damage of infants undergoing VSD