三种全程麻醉方式对二尖瓣瓣膜置换术患者cTnⅠ和CK-MB的影响

The Effect of Different General Anesthesia Methods on cTnI and CK-MB in Mitral Valve Replacement Patients

目的比较丙泊酚静脉麻醉、七氟醚吸入麻醉及丙泊酚、七氟醚静吸复合麻醉三种全程麻醉维持方式对二尖瓣瓣膜置换术患者体外循环缺血再灌注损伤心肌的影响。方法选择45例患者,随机分丙泊酚组(P组)、七氟醚组(S组)、丙泊酚复合七氟醚组(PS组),每组15例,分别采用丙泊酚、七氟醚、丙泊酚复合七氟醚全程维持麻醉。在诱导后、体外循环前、体外循环后、手术结束即刻分别记录患者的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)。在手术前(T0),升主动脉开放后2 h(T2)、4 h(T4)、8 h(T8)、24 h(T24)、48 h(T48),采集动脉血测定心肌肌钙蛋白I(cTnI)、血浆肌酸激酶同工酶(CK-MB)。结果三组各时点HR、MAP、CVP差异无统计学意义(P>0.05)。三组患者血浆cTnI、CK-MB在T2、T4、T8、T24、T48明显升高,P组、PS组于T8达高峰,而S组于T4达高峰。与P组、PS组相比,S组cTnI在T2、T4、T8、T24、T48明显降低(P<0.05),CK-MB在T2、T4、T8、T24、T48明显降低(P<0.05)。结论对于在体外循环下行二尖瓣瓣膜置换术的患者,与全程丙泊酚或丙泊酚复合七氟醚维持麻醉相比,全程七氟醚维持麻醉有较好的心肌保护作用。

Objective To compare the affection of propofol, sevoflurane and propofol combined sevoflurane on myocardial isehemia-reperfusion injury in the mitral valve replacement surgery patients with cardiopulmonary bypass. Methods 45 patients were randomly assigned to propofol group （P）, sevoflurane group （S）, and propofol combined with sevoflurane group （PS）, with 15 cases each group. Propofol, sevoflurane and propofol combined with sevoflurane were used throughout anesthesia, respectively. The patient＇s heart rate （HR）, mean arterial pressure （MAP）, central venous pressure （CVP） were recorded before surgery, before CPB, after CPB and at the end of surgery. Determination of Arterial blood cardiac troponin I （cTnI） plasma creatine kinase isoenzyme （ CK-MB ） before surgery 2 h （ T2 ） ,4 h （ T4 ）, 8 h （ Ts ）, 24 h （ T24 ） ,48 h （ T48 ） after the ascending aorta open was performed. Results HR, MAP and CVP of three groups at each time point were not significantly different （ P 〉 0.05 ）. cTnI, CK-MB significantly increased at T2,T4, T8,T24,T48 and reached the peak at T8 in group PS and group P while at T4 in group S. Compared with group P and group PS, cTnI of group S at T2, T4, T8, T24, T48, was significantly lower（P 〈 0.05 ） and with CK-MB significantly lower （ P 〈 0.05 ） at T2, T4, T8, T24, T48. Conclusion Compared with propofol group and propofol combined with sevoflurane group, the whole use of sevoflurane anesthesia was beneficial to myocardial protection for patients with mitral valve replacement surgery in cardiopulmonary bypass surgery.