七氟烷、丙泊酚麻醉对心脏瓣膜置换手术患者心肌损伤标志物影响的研究

Influence of Sevoflurane or Propofol Anesthesia Methods for The Myocardial Injury Markers of Patients with Heart Valve Replacement Surgery

日的比较全程吸入七氟烷或靶控输注丙泊酚两种麻醉方法在心脏瓣膜置换手术对心肌保护的效应．方法择期风湿性心脏瓣膜置换手术成人患者30例，ASA分级Ⅱ-Ⅲ级，心功能分级（NYHA）IL-Ⅲ级．随机均分为七氟烷组（S组）和丙泊酚组（P组）．S组患者麻醉诱导给予全凭七氟烷诱导维持；P组患者麻醉采用靶控输注丙泊酚全凭静脉麻醉诱导维持，术中间断推注芬太尼、罗库溴铵，维持BIS40～60、平均动脉血压〈±20％基础平均动脉压、中心静脉压5—15crnHzO．记录患者的一般情况，记录麻醉诱导前（T0）、主动脉插管即刻（TI）、主动脉开放后30min（T2）、主动脉开放后6h（T3）、主动脉开放后24h（T4）各个时点的心肌肌钙蛋白I（cTnI）、磷酸肌酸激酶（CK）、磷酸肌酸激酶同工酶（CK—MB）及乳酸（LAC）指标．结果2组患者的一般情况、手术和麻醉经过等一般资料经统计学检验，各组间差异无统计学意义（P〉0．05）；2组患者术前的cTnI、CK、CK—MB及LAC指标均在正常范围内，在T2及T3、rr4时点升高，以T3时点升高最显著（P〈0．01），2组间在各个时点比较差异无统计学意义（P〉0．05）．结论以心肌损伤标志物心肌肌钙蛋白I为评价心肌保护效应指标，术中全程吸人七氟醚与全程丙泊酚静脉麻醉比较，两者对心肌肌钙蛋白I的释放水平的影响无差异．

Objective To compare the influence of whole sevoflurane inhaling and target-controlled infusion of propofol for the myocardial protective effect on patients with heart valve replacement surgery. Methods 30 adult patients who went through heart valve replacement surgery with cardiopulmonary by pass were selected, including ASA staging II-III and cardiac function classification （NYHA） II-III. All patients were randomly divided equally into sevoflurane group （Group S） and propofol group （Group P） . Patients were monitored before anesthetic induction. Group S got 1% sevoflurane （fresh gas flow 6 L/min） with concentration of the vaporizer increased from 1% to 3% with 1 minute interval during anesthetic induction. Group P got target-controlled infusion of propofol during anesthetic induction, the initial target plasma concentration was set at 0.8 μg/mL, and the concentration increased 0.5 μg/mL every minute until intubation. All the patients got fentanyl 5 μg/kg and rocuronium 0.6 mg/kg, and intubation was conducted when BIS decreased lower than 60 and mean arterial pressure （MAP） 〈 20% basic MAP. During anesthesia maintaince, patients got 0.5-2 MAC sevoflurane inhaling or target-controlled infusion of propofol 2-4 μg/mL with discontinuous intravenous fentanyl and rocuronium, and maintained BIS 40-60, MAP 〈 ± 20%basic MAP, central venous pressure 5-15 cm H20. Outcome variables included demographic characteristics of patients. The following parameters were also recorded, including cardiac troponin I （cTnI） , creatine kinase （CK） , creatine kinase isoenzyme （CK-MB） and lactate （LAC） in before anesthetic induction （TO） , aortic inbation （T1）, 30 minutes after aorta opening （T2）, 6 hours after aorta opening （T3） and 24 hours after aorta opening （T4） . Results There was no statistical significance in demographie characteristics during peri-operation between the two groups （P 〉 0.05） . The pre-opertaive cTnI, CK, CK-MB and LAC were within the normal range, but increased siginieantly on T2, T3 and T4, and was more significant on T3 （P 〈 0.01） between two groups, and the intra-group comparison showed no difference on other time points. Conclusion When myocardial injury markers used as myocardial protection outeome variables, whole sevoflurane inhaling could not reduce the release of eTnI compared to propofol TIVA in heart valve replacement surgery.