舒芬太尼麻醉对非体外循环冠脉搭桥术患者血浆肌钙蛋白I的影响

Affection of sufentanil anesthesia on lowers cardiac troponin I levels in patients undergoing off-pump coronary artery bypass graft surgery

目的:应用心肌肌钙蛋白I(cTnI)评价舒芬太尼麻醉对非体外循环冠脉搭桥(OPCAB)患者的心肌保护作用。方法:选择20例行OPCAB的冠心病患者,随机分为舒芬太尼麻醉组(S组)和对照组芬太尼(F组)。所有患者术前口服安定10mg,肌肉注射吗啡10 mg、东莨菪碱0.3 mg,全麻诱导静脉注射咪唑安定0.1 mg/kg,哌库溴铵0.1mg/kg诱导,S组:舒芬太尼10ug/kg,F组:芬太尼10ug/kg,持续静脉输注异丙酚;间断给予S组舒芬太尼,F组:芬太尼,哌库溴铵0.05 mg/kg。测定术前、术毕及术后2、6、24、48小时血浆cTnI水平。结果:各组内术后cTnl水平均明显增高(P<0.05)。S组术后cTnI水平显著低于F组(P<0.05)。结论舒芬太尼麻醉处理可降低OPCAB患者的cTnI水平,减轻心肌损伤。

Objective：To investigate the value of cardiac troponin I （cTnI）levels in assessing myocardial protection by Sufentanil anes- thesia against myocardial, injury induced by off - pump coronary artery bypass （OPCAB）. Methods ： Twenty patients undergoing OPCAB were randomized into fentanil and Sufentanil anesthesia group （n -- 10）. All the patients received pretreatment with oral diazepam （10rag） intramuscular morphine （10 rag）and hyosine（0.3 rag）. anesthesia was induced with midazolam （0.10 mg/kg）, Pipecuronium Bromide （ 0.1 mg/kg ）, S group ： Sufentanil （10ug/kg） F group ： fentanil （10ug/kg） , and maintained with propofol infusion ; Intermittent S group ： Sufentanil F group： fentanil and pipecuronium Bromide 0.05 mg/kg were given intravenously . Blood samples were obtained before and at0, 2,6,24, and 48 h after the operation to determine serum cTnI levels. Results： In both of the two groups, the cTnI levels increased sig- nificantly at the postoperative time points （ 0,2,6,24, and 48 h） as compared with those before the operation （ P 〈 O. 05 ）. The cTnI levels of Sufentanil anesthesia group were markedly decreased after the operation in comparison with those of the control group（ P 〈 0.05 ）. Conclu- sion：Snfentanil anesthesia could decrease the cTnI levels and reduces myocardial injury induced by OPCAB.