不同七氟醚后处理对体外循环下冠状动脉旁路移植术患者心肌损伤的影响

Effect of different sevoflurane postconditioning on myocardial injury in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass

目的：评价不同七氟醚后处理对体外循环（CPB ）下冠状动脉旁路移植术（CABG ）患者心肌损伤的影响。方法择期CPB下 CABG患者75例，年龄46～72岁，体重57～90 kg ，性别不限， NYHA心功能分级Ⅰ或Ⅱ级。采用随机数字表法，将其分为5组（ n＝15）：对照组（Ⅰ组）、持续1.7％七氟醚后处理组（Ⅱa组）、持续3.4％七氟醚后处理组（Ⅱb组）、间断1.7％七氟醚后处理组（Ⅲa组）和间断3.4％七氟醚后处理组（Ⅲb组）。Ⅰ组不给予七氟醚；Ⅱa组于乳内动脉至冠状动脉前降支吻合口开放后由CPB机向人工膜肺中持续洗入1.7％七氟醚15 min；Ⅱb组于吻合口开放后持续洗入3.4％七氟醚15 min；Ⅲa组于吻合口开放后洗入1.7％七氟醚5 min ，停药5 min后再次恢复给药5 min ，共计15 min；Ⅲb组于吻合口开放后洗入3.4％七氟醚5 min ，停药5 min后再次恢复给药5 min ，共计15 min。于CPB前、术后6和24 h时测定血浆肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶和心肌肌钙蛋白I的浓度，于CPB前和停机后取右心耳组织，电镜下观察心肌超微结构。结果与Ⅰ组比较，Ⅱb组术后6和24 h时血浆心肌肌钙蛋白I浓度降低（ P＜0.05），其余血浆测定指标差异无统计学意义（ P＞0.05）；CPB后各后处理组心肌病理学损伤程度较Ⅰ组减轻，尤其Ⅱb组减轻程度显著。结论持续3.4％七氟醚15 min后处理可减轻CPB下CABG患者心肌损伤。

Objective To evaluate the effect of different sevoflurane postconditioning on myocardial injury in patients undergoing coronary artery bypass grafting （CABG ） with cardiopulmonary bypass （CPB ） .Methods Seventy-five NYHA class Ⅰ or Ⅱ patients ,aged 46-72 yr ,weighing 57-90 kg ,scheduled for elective CABG with CPB ,were randomly divided into 5 groups （ n=15 each） using a random number table ：control group （groupⅠ） , postconditioning with continuous administration of 1.7% sevoflurane group （groupⅡ a ） , postconditioning with continuous administration of 3.4% sevoflurane group （group Ⅲa） ,postconditioning with interrupted administration of 1.7% sevoflurane group （Ⅱb） and postconditioning with interrupted administration of 3.4% sevoflurane group （group Ⅲb） .Sevoflurane was not given in group Ⅰ .In Ⅱa group ,after the anastomotic stomas of the internal mammary artery to anterior descending artery were released ,the patients continuously inhaled 1.7% sevoflurane for 15 min .In Ⅱb group ,after the anastomotic stomas were released .In Ⅲa group ,after the anastomotic stomas were released , the patients continuously inhaled 3.4% sevoflurane for 15 min , the patients inhaled 1.7%sevoflurane for 5 min first ,inhalation was interrupted for 5 min ,and then inhalation was recovered lasting for 5 min ,and it was 15 min in total .In Ⅲb group ,after the anastomotic stomas were released ,the patients inhaled 3.4% sevoflurane for 5 min first ,inhalation was interrupted for 5 min ,and then inhalation was recovered lasting＆nbsp;for 5 min ,and it was 15 min in total .Venous blood samples were taken for determination of the plasma creatine kinase ,creatine kinase isoenzyme-MB , lactic dehydrogenase , and cardiac troponin I concentrations before CPB and at 6 and 24 h after operation .Myocardial specimens were obtained from the right auricle before CPB and after termination of CPB for microscopic examination of the ultrastructure .Results Compared with group Ⅰ , the concentration of cardiac troponin Ⅰ was significantly decreased at 6 and 24 h after operation （ P0.05 ） .The pathological changes were significantly attenuated in sevoflurane postconditioning groups as compared with group Ⅰ ,especially in Ⅱb group . Conclusion Postconditioning with continuous administration of 3.4% sevoflurane for 15 min can attenuate myocardial damage in patients undergoing CABG with CPB .