瑞芬太尼预处理对心肺转流心脏缺血后损伤的保护作用

Protective effect of preconditioning with remifentanil on cardiac ischemic injury in patients undergoing cardiopulmonary bypass

目的 观察瑞芬太尼预处理对心肺转流心脏缺血后损伤的影响。方法 将本院72例室间隔缺损患者,ASAⅡ~Ⅲ级,随机分为观察组和对照组,每组36例。两组均给予咪唑安定、依托咪酯、瑞芬太尼、维库溴铵行麻醉诱导,术中丙泊酚、瑞芬太尼、七氟醚和维库溴铵维持麻醉深度。观察组于主动脉阻断前泵注瑞芬太尼1.0μg/（kg·min）5 min,随后停止给药5 min,再泵注瑞芬太尼1.0μg/（kg·min）5 min;对照组则泵注生理盐水。比较两组围术期不同时点血压、心率、心肌肌钙蛋白I（CTn I）和磷酸肌酸激酶同工酶（CK-MB）水平差异。结果 两组入室后、气管插管前、气管插管后、预处理时、切皮时、心肺转流前心率、血压均无统计学差异（P〉0.05）,观察组主动脉开放即刻、6、12和24 h时的CTn I和CK-MB水平均低于对照组（P〈0.05）。结论瑞芬太尼预处理有助于降低心肺转流心脏缺血后CTn I和CK-MB水平,具有一定的心脏保护作用。

Objective To observe the effects of preconditioning with remifentanil on cardiac ischemic injury in patients undergoing cardiopulmonary bypass. Methods Seventy two patients with ventricular septal defect （VSD） and ASA Ⅱ - Ⅲ were selected and randomly divided into two groups with 36 ones in each group. Patients in both groups were given midazolam, etomidate, remifentanil, and vecuronium for anesthesia induction. During the operation, propofol, remifentanil, sevoflurane, and vecuronium were used to maintain anesthesia depth. Patients in the observation group received pumping with remifentanil 1.0 μg/（kg·win） for 5 min before aortic block. Then after a stop of administration for 5 win, they again received the pumping with remifentanil 1.0 μg/（kg·win） for 5 min. Patients in the control group received pumping with normal saline. Comparison was made in the differences in blood pressure, heart rate, cardiac troponin-I （CTnI） and creatine kinase-MB isoenzyme （CK-MB） levels at different time points during perioperative period between the two groups.Results There were no significant difference in heart rate and blood pressure after entering the operation room, before and after the tracheal intubation, at the time of pretreatment, skin incision, and before cardiopulmonary bypass（P 〉 0.05）. The levels of CTnI and CK-MB in the observation group were lower than those in the control group at the time of aorta opening, the 6th, 12th, and 24th hour after the opening （P 〈 0.05）. Conclusion Preconditioning with remifentanil can decrease the levels of CTnI and CK-MB in patients with heart ischemia after cardiopulmonary bypass, which has a certain protective effect on heart.