七氟醚后处理对二尖瓣置换术患者左心室舒张功能及脑钠肽的影响

Effects of sevoflurane postconditioning on left ventricular diastolic function and brain natriuretic peptide in patients undergoing mitral valve replacement

目的观察七氟醚后处理对心肺转流（CPB）下二尖瓣置换术（MVR）患者左心室舒张功能及脑钠肽（BNP）的影响。方法择期CPB下行MVR的风湿性二尖瓣病变患者40例，年龄30～73岁，ASAⅡ或Ⅲ级。患者随机分为两组，P组与S组术中均持续静脉输注丙泊酚维持麻醉，S组停CPB后在静脉麻醉基础上吸入七氟醚0．5～1MAC。于锯胸骨前（T1）和停CPB后5min（T2）、30min（T3）、60min（T4）采用经食管超声心动图（TEE）监测经二尖瓣舒张早期血流速度（E）与二尖瓣环舒张早期组织速度（E’）的比值（E／E’）、左心室舒张早期血流播散速度（Vp）。检测T1、停CPB后60min（T4）和术后12h（T5）、24h（T6）血中BNP水平。结果与T1时比较，T3、T4时P组E／E’明显增大（P〈0．05）；与T1时比较，T6时P组与S组BNP水平均明显升高（P〈0．05）；与T4时比较，T5、T6时P组与S组BNP水平均明显升高（P〈0．05）。结论对于CPB下行MVR患者，停机后吸入0．5～1MAC七氟醚对左心室舒张功能的减退有改善作用。术后BNP水平升高，不依赖于停机后是否吸入七氟醚。

Objective To evaluate the effects of sevoflurane postconditioning on left ventricular diastolic function and brain natriuretic peptide in patients undergoing mitral valve replacement（MVR） under cardiopulmonary bypass （CPB）. Methods Forty ASA II or Ill patients aged 30-73 years weighing 37-86 kg undergoing MVR under CPB were randomly divided into two groups （n = 20）： group propofol（group P） and group sevoflurane postconditioning （group S）. Anesthesia was both maintained with intravenous propofol in both groups and inhalation of 0.5-1 MAC sevoflurane after CPB was administered in group S. The ratio of early diastolic transmitral velocity to early diastolic tissue velocity（E/E＇）,M-mode Doppler flow propagation velocity（Vp）, E/Vp were measured before sternotomy （T1） and at 5 min （ T2 ）, 30 rain （Ts）, 60 rain （T4） after CPB by transesophageal echocardiography （TEE）. The BNP levels of patients were measured before sternotomy（T1 ） and at 60 min（T4 ）after CPB and at 12 h（T5）, 24 h（T6 ） after surgery. Results Compared with T1 , E/E＇ of group P was increased at T3 and T4 （P〈0.05）, but there was no statistical significance in group S. Compared with T1 , BNP level of group P and group S were increased at T6 （P〈0.05）. Compared with T4, BNP level of group P and group S were increased at T5 and T6 （P〈0.05）. Among these two groups, there was no statistical significance of BNP levels at four time points. Conclusion For the patients undergoing MVR under CPB, 0. 5-1 MAC sevoflurane inhalation after CPB can ameliorate LV diastolic dysfunction. However, sevoflurane postconditioning has no effect on BNP increase after CPB.