异氟醚预处理对心肺转流冠状动脉搭桥手术患者的心肌保护作用

Myocardial protective effects of isoflurane preconditioning during CABG under cardiopulmonary bypass

目的观察异氟醚预处理对心肺转流(CPB)冠状动脉搭桥手术(CABG)患者心肌的保护作用。方法 CABG患者20例,随机均分为异氟醚预处理组(A组,CPB开始前持续吸入1.5MAC异氟醚10min,然后洗脱10min)和对照组(B组,不行异氟醚预处理),分别于麻醉后(T1)、主动脉开放后15min(T2)、CPB结束后2h(T3)和24h(T4)检测血清降钙素基因相关肽(CGRP)、血管内皮素(ET)和心肌钙蛋白(cTnI)。结果 T2、T3和T4时,两组CGRP明显高于T1(P<0.01),但T2、T3时A组高于B组(P<0.05);T2、T3时,两组ET均明显高于T1(P<0.01),但A组低于B组(P<0.05);T2、T3和T4时,两组cTnI均高于T1(P<0.01),但T3和T4时,A组明显低于B组(P<0.01)。结论异氟醚预处理能减少心肌的缺血-再灌注损伤。

Objective To investigate the myocardial protective effects of isoflurane preconditioning during coronary artery bypass grafting（CABG） under cardiopulmonary bypass（CPB）. Methods Twenty CABG patients under CPB were equally randomized into two groups of A （1.5 MAC isoflurane inhalation for 10 rain and washing out for 10 min before CBP） and B（without isoflurane inhalation）. Blood samples were taken for the measurements of Calcitonin gene-related peptide（CGRP）, endothelin （ET） and calcitonin-I （cTnI） after anesthesia induction （T1）, at 15 rain after aorta unclamping（T2）, 2 h（T3） and 24 h（T4） after CPB. Results Compared to T1, serum CGRP levels o[ both groups were increased at T2,T3 and T4（P〈0. 01） ,which at T2 and T3 were higher in group A than those in group B（P〈0. 05）. Compared to T1, serum ET levels of both groups were increased at T2 and T3 （P〈0. 01）,which were lower in group A than those in group B（P〈0. 05）. Compared to T1, serum cTnI levels of both groups were increased at T2,T3 and T4（P〈0. 01）, which at T3 and T4 were lower in group A than those in group B （P〈0. 01 ）. Conclusion Isoflurane preconditioning can protect the myocardium against ischemia-reperfusion jury in CABC under CPB.