丙泊酚对风心瓣膜置换术转流后左室功能的影响

Effect of propofol on left ventricular function in the patients undergoing cardiac valve replacement

目的 观察丙泊酚静脉复合麻醉对风心瓣膜置换手术患者心肺转流 (CPB)后左室功能的影响。方法 2 0例风心瓣膜置换手术患者 ,随机分为咪唑安定组 (C组n =10 )和丙泊酚组 (P组n=10 ) ,分别以咪唑安定 0 1～ 0 2mg·kg-1·h-1或丙泊酚 2～ 6mg·kg-1·h-1维持麻醉 ,CPB期间和CPB后持续注药。两组芬太尼应用相同。观察缺血 /再灌注后 3 0分钟、60分钟和 2 4小时血清心肌酶谱变化 ,并采用Swan Ganz导管技术监测停CPB后MAP、HR、SI、CI、PCWP、SVRI和LVSWI变化。结果 缺血 /再灌注后三个时点LDH和CK MP均较麻醉前升高 ,C组升高更为明显。CK MB再灌注后 60分钟和 2 4小时 ;LDH再灌注 2 4小时与P组相比差异显著 (P <0 0 5 )。P组停CPB后各时点HR较基值显著减慢 (P <0 0 1) ,PCWP、SVRI显著降低 (P <0 0 1) ,SI、LVSWI显著增高 ,CI较C组相对为高。结论 丙泊酚维持麻醉 ,减轻了心肌缺血 /再灌注损伤 ,并降低心脏前、后负荷 ,维持满意的心脏指数 ,促进缺血后左心功能的恢复。

Objective To observe the effects of propofol on left ventricular function and the serum myocardial enzymes in patients undergoing cardiac valve replacement.Methods Twenty patients were randomly divided into group C( n= 10)and group P( n= 10)receiving a infusion of midazolam 0 1 0 2mg·kg -1 ·h -1 (group C)or propofol 2 6mg·kg -1 ·h -1 (group P) respectively during anesthesia.The activities of serum myocardial enzymes were measured at 30min,60min and 24h after reperfusion.The hemodynamic changes were monitored with Swan Ganz catheterization before and after CPB.Results The concentration of LDH and CK MB in group P were lower than those in group C.After completion of CPB,HR,PCWP and SVRI in group P were significantly lower than the baselines ( P< 0 01).SI and LVSWI were significantly higher than the baselines ( P< 0 05).CI in group P was higher relatively than that in group C.Conclusion Propofol combined with fentanyhl anesthesia can attenuate the degree of myocardial ischemia reperfusion injury,decrease preload and afterload and effectively improve cardiac index after CPB.