异丙酚和依托咪酯对心内直视手术患者再灌注损伤的影响

Influence of propofol and etomidate on reprfusion injury in patients undergoing open heart surgery

目的 :比较等效麻醉剂量的异丙酚和依托咪酯对体外循环下心内直视术患者心肌缺血再灌注损伤的影响。方法 :将 2 0例择期体外循环下心内直视术患者随机分为两组 :异丙酚组 (P组 )、依托咪酯组 (E组 ) ,每组 10例。两组分别用异丙酚 2 m g/ kg,依托咪酯 0 .3mg/ kg诱导 ,然后均采用芬太尼 5 μg/ kg和卡肌宁 0 .3m g/ kg间断静脉注射 ,同时吸入 0 .5 %～ 2 %安氟醚维持麻醉。分别于诱导前 (T0 )、主动脉开放后 10 min(T1 )、2 4h(T2 )和 7d(T3) ,测定心肌肌钙蛋白 (Tn T)和肌酸磷激酸酶同功酶 (CK— MB) ,并记录心脏复跳的方式 ,心律失常的发生 ,使用升压药及术后并发症的情况。结果 :与诱导前相比 ,两组患者开放主动脉 10 m in后 Tn T和 CK— MB均明显升高 (P<0 .0 5或 P<0 .0 1) ,其中 P组小于 E组同时值 ,(P<0 .0 5 ) ,主动脉开放后需电击复跳 ,伴有心律失常和术后并发症的例数 ,P组少于E组。结论 :异丙酚减轻体外循环下心肌缺血再灌注损伤的作用 。

Objective:To compare the influence of propofol and etomidate on reperfusion injury duning Cardio pulmonary bypass.Methods:Twenty patients.Scheduled for elective cardio pulmonary bypass,were divided into propofolp and etomidatect) groups.At induction a bolus of propofol 2.0 mg/kg was given in group p and a bolus of etomidate 0.3 mg/kg was given in group E.Then two groups were infused Fentanyl 5μg/kg and Atracurium 0.3 mg/kg and inhaled Enflurance 0.5 %～2 % to maintain anesthesid.The venous blood samples were taken to measured the TnT and CK-MB at the following Result:before induction(To).10 min?24h and a week after release of the arotic cross-clamp) (T 1?T 2?T 3).Results As compared with thoes before induetion.The value of TnT and CK-MB increased significally in two groups following declamping( P <0.05 or P <0.01).The value in group P was Lower then that in group E.The incidence of resorting spontaneous heart-beat was markedly higher in group E than those in group P.Condusion:Propofol reduce reperfusion injury much move than equiralent dose of etomidate undergoing cardio pulmonary bypass.