摘要
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 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 .
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2014年第3期304-307,共4页
Chinese Journal of Anesthesiology
关键词
麻醉药
吸入
缺血后处理
心肺转流术
心肌
Anesthetics,inhalation
Ischemic postconditioning
Cardiopulmonary bypass
Myocardium