体外循环旁路洗入七氟醚对冠状动脉旁路移植术患者心肌炎性反应的影响

Effects of sevoflurane wash-in during cardiopulmonary bypass on inflammatory responses in patients undergoing coronary artery bypass grafting

目的 评价CPB旁路洗入七氟醚对冠状动脉旁路移植术（CABG）患者心肌炎性反应的影响.方法 择期CPB下行CABG的患者40例,年龄45 ～ 60岁,体重53～ 89 kg,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将其分为2组（n=20）：对照组（C组）和七氟醚组（S组）.S组于CPB期间通过体外循环机洗入1.0％ ～2.0％七氟醚.于麻醉诱导后5 min、CPB结束后4、12和24 h时,采集中心静脉血样,测定血浆心肌肌钙蛋白Ⅰ（cTnI）浓度.于CPB结束时取右心耳组织,采用免疫组化法测定IL-6和IL-1β的表达.结果 与C组比较,S组血浆cTnI浓度降低,心肌组织IL-Iβ和IL-6表达下调（P＜0.05）.结论 CPB旁路洗入七氟醚减轻CABG患者心肌损伤的机制与其抑制炎性反应有关.

Objective To investigate the effects of sevoflurane wash-in during cardiopulmonary bypass （CPB） on inflammatory responses in patients undergoing coronary artery bypass grafting （CABG）.Methods Forty ASA physical status Ⅱ or Ⅲ patients,aged 45-60 yr,weighing 53-89 kg,scheduled for elective CABG under CPB,were randomly divided into 2 groups （n =20 each） using a random number table：control group （group C） and sevoflurane group （group S）.Sevoflurane 1％-2％ was washed into the extracorpomal circuit during CPB in group S.Blood samples were taken from the central vein at 5 min after induction of anesthesia and 4,12 and 24 h after termination of CPB for determination of the concentration of plasma cardiac troponin Ⅰ （cTnI）.Myocardial specimens were obtained from the right auricle at the end of CPB for determination of IL-Iβ and IL-6 expression by immuno-histochemistry.Results Compared with group C,the plasma concentration of cTnI was significantly decreased,and IL-1β and IL-6 expression in myocardial tissues was down-regulated in group S （P ＜ 0.05）.Conclusion The mechanism by which sevoflurane wash-in during CPB attenuates myocardial injury is related to inhibition of inflammatory responses in patients undergoing CABG.