七氟醚不同吸入方式对瓣膜置换术患者血清肌钙蛋白-T及炎性细胞因子的影响

The effects of different ways of conditioning with sevoflurane inhalation on serum !concentrations of troponin-T and inflammatory cytokines after valve replacement surgery

目的 观察七氟醚不同吸入方式对心肺转流（CPB）下心脏瓣膜置换术中血清肌钙蛋白T（cTnT）和炎性细胞因子IL,-6、IL-8浓度的影响,探讨不同七氟醚处理方法的心肌保护作用及其机制.方法 52例拟行全身麻醉下CPB心脏瓣膜置换术的患者,随机均分为：七氟醚预处理组（S1组）、七氟醚后处理组（S2组）和七氟醚预处理联合后处理组（S3组）和对照组（C组）.S1组：麻醉诱导后连续吸入1％七氟醚至主动脉阻断;S2组：主动脉、腔静脉开放后连续吸入1％七氟醚至手术结束;S3组：麻醉诱导后连续吸入1％七氟醚至主动脉阻断时停止,主动脉、腔静脉开放后再连续吸入1％七氟醚至手术结束;C组在整个麻醉手术期间不吸入七氟醚.于麻醉诱导后即刻（T0）、主动脉开放后2 h（T1）、6 h（T2）、12 h（T3）和24 h（T4）分别采集桡动脉血3ml,测定cTnT、IL-6和IL-8浓度.结果 与T0时比较,T1～T3时S1组、S2组和S3组血清cTnT、IL-6和IL-8浓度明显升高（P＜0.05）.与C组比较,T1～T3时S1组、S2组和S3组血清cTnT、IL-6和IL-8浓度明显降低（P＜0.05）;而T4时S1组、S3组血清cTnT浓度和S1组、S2组和S3组血清IL-6、IL-8浓度明显降低（P＜0.05）.结论 七氟醚预处理、七氟醚后处理和七氟醚预处理联合后处理三种方式均可有效显减轻瓣膜置换术中心肌缺血-再灌注损伤,心肌保护作用相近,机制可能与抑制全身炎症反应有关.

Objective To investigate the influence of different sevoflurane treatment ways,including sevoflurane preconditioning,sevoflurane postconditioning and combination of sevoflurane preconditioning and postconditioning on serum concentrations of troponin T（cTnT）,interleukin （IL-6） and IL-8 for exploring myocardial protection of these methods and the underlying mechanisms in adult patients during valve replacement surgery under cardiopulmonary bypass （CPB）.Methods Fifty-three patients scheduled for valve replacement surgery under CPB were enrolled and divided randomly into four groups （n =13 each）：sevoflurane preconditioning group （group S1）,sevoflurane postconditioning group （group S2）,combination of sevoflurane preconditioning and postconditioning group （group S3） and control group （group C）.1％ sevoflurane was inhaled after endotracheal intubation until aorta clamping in group S1.1％ sevoflurane was inhaled after aorta declamping and vena cava release in group S2.1％ sevoflurane was inhaled after endotracheal intubation until aorta clamping and after aorta declamping and vena cava release in group S3.No sevoflurane was inhaled during the procedure in group C.The artery blood samples were collected for the measurements of serum concentration of cTnT,IL-6 and IL-8 immediately after anesthesia induction（T0）,at 2 h（T1）,6 h（T2）,12 h（T3） and 24 h（T4） after aorta declamping respectively.Results Compared with T0,the serum concentrations of cTnT,IL-6 and IL-8 increased significantly in all groups at T1-T3 （P＜0.05）.However,the serum concentrations of cTnT,IL-6 and IL-8 were significantly lower in groups S1,S2 and S3 than those in group C at T1-T3 （P＜0.05）.At T4,the concentrations of serum cTnT in groups S1 and S3 and serum IL-6,IL-8 in groups S1,S2 and S3 were significantly lower than those in group C （P＜0.05）.Conclusion The findings revealed that sevoflurane preconditioning,sevoflurane post conditioning and combination of sevoflurane preconditioning and postconditioning can all remarkably reduce myocardial ischemia-reperfusion injury.All the conditioning modes can protect myocardium from ischemia-reperfusion injury to a similar extent.The myocardial protective effects may be related to attenuation of systemic inflammatory response syndrome.