舒芬太尼对非体外循环冠状动脉旁路移植术的心肌保护

The protective effects of sufentanil on myocardium of patients received off-pump coronary artery bypass grafting

目的:研究在行非体外循环冠状动脉旁路移植术(OPCABG)时,舒芬太尼对心肌的保护作用。方法:择期行OPCABG的患者60例,年龄52～75岁,ASAⅡ或Ⅲ级,随机分为舒芬太尼组和芬太尼组,每组30例。舒芬太尼组用舒芬太尼1μg/kg,芬太尼组用芬太尼10μg/kg进行麻醉诱导,分别于切皮、劈胸骨、钳夹主动脉侧壁、关胸前追加舒芬太尼每次0.8μg/kg(舒芬太尼组)或芬太尼每次8μg/kg(芬太尼组)维持麻醉。于麻醉诱导前(T0)、桥血管吻合结束(T1)、手术结束即刻(T2)、术毕8、16和24 h(T3-5),采集桡动脉血10 ml分离血清,用酶联免疫法分别测定两组患者血清IL-6、IL-10、CK-MB、心肌肌钙蛋白I(cTnI)水平及超氧化物歧化酶(SOD)活性。结果:与芬太尼组比较,舒芬太尼组血清cTnI水平在T4～5时显著降低(P<0.05),IL-6水平在T1～4时降低(P<0.05),IL-10在T1～4时升高(P<0.05),SOD活性在T1～3时升高(P<0.05)。结论:舒芬太尼对OPCABG的心肌具有保护作用,其机制可能与抗炎、清除自由基、减少氧化应激等有关。

Objective： To evaluate the myocardial protective effects of sufentanil in patients received off-pump coronary artery bypass grafting （OPCABG）. Methods： Sixty patients, who aged 52 to 75 years with ASA II or III, for selected OPCABG operation were randomly divided into the sufentanil group （Group S） and fentanyl group （Group F）. Sufentanil （1 μg/kg） and Fentanyl （10μ g/kg） were used in Group S and Group F, respectively, during anesthesia induction. Sufentanil （0. 8 μg/kg） and fentanyl （81μg/kg） were also applied for anesthesia maintenance at skin incision, sternotomy, clamping aortic sidewall, and the end of operation in Group S and Group F, respectively. The radial artery blood samples were obtained before induction of anesthesia （T0 ）, at the end of the blood vessels suture （ T1 ） , at the end of operation （ T2 ）, and 8, 16 and 24 hours after operation （ T3-5 ）. The interleukin-6 （IL-6）, interleukin-10 （IL-10）, creatine kinase isoenzyme-MB （CK-MB）, and cardiac troponin I （cTnI） concentrations, and activity of superoxide dismutase （SOD） were assessed with enzyme-linked immunosorbent assay. Results： In Group F, the concentrations of cTnI were significantly lower than those in Group S at T4-5, with significantly lower IL-6 between T1.4, significantly higher IL-10 between T1.4, and significantly higher activity of SOD between T,.3 （P 〈 0. 05）. Conclusion： Sufentanil provides myocardial protection in the OPCABG, probably via anti-inflammatory, scavenging free radicals, and reducing oxidative stress.