七氟醚对冠状动脉旁路移植术患者左心室纵向和环向运动的影响

Effect of sevoflurane in left ventricular longitudinal motion and circular motion for patients undergoing on coronary artery bypass grafting(CABG)

目的评价七氟醚对心肺转流（CPB）下冠状动脉旁路移植术（CABG）患者左心室纵向运动及环向运动的影响。方法择期CPB下行CABG患者26例,年龄45~75岁,身高152~181cm,体重43~78kg,ASAⅡ或Ⅲ级,NYHA 2或3级。采用随机数字表法,将其分为两组：观察组（S组,n=15）、对照组（C组,n=11）。S组在停CPB 15min后吸入呼气末浓度相当于l MAC七氟醚30min,随后洗脱30min,C组未吸入七氟醚。于锯胸骨前（T0）、停止CPB后15 min吸入七氟醚前（T1）、吸入七氟醚30min（T2）、洗脱30min（T3）时记录MAP、HR、CVP、肺动脉阻塞压（PAOP）和经食管超声心动图（TEE）监测指标：左心室射血分数（LVEF）、心排出量（CO）、每搏量（SV）、左心室纵向运动全局应变均数（GLS）、左心室环向运动全局应变均数（GCS）。结果 T1、T2时S组,T1~T3时C组HR明显快于T0时;T2、T3时S组HR明显慢于T1时和C组（P〈0.01或P〈0.05）。T2时S组MAP明显低于T0时（P〈0.05）,T3时S组MAP明显高于T2时（P〈0.05）。两组CVP、PAOP组间组内差异无统计学意义。T1时两组CO、SV和LVEF明显高于T0时,T2、T3时C组CO明显高于T0时（P〈0.01或P〈0.05）。T1、T3时S组,T1、T2时C组GLS明显高于T0时,T3时S组GLS明显高于T2时,C组明显高于T1时;T2时S组GLS明显低于C组（P〈0.01或P〈0.05）。T1、T3时两组GCS明显高于T0时,T3时S组GCS明显高于T2时,T2时S组GCS明显低于C组（P〈0.01或P〈0.05）。结论 CPB后吸入呼气末浓度1 MAC的七氟醚同时抑制了左心室心肌的纵向运动及环向运动。

Objective The study was designed to investigate the effect of sevoflurane on left ventricular longitudinal motion and circular motion for patients undergoing on coronary artery bypass grafting（CABG）. Methods Twenty-six cases, NYHA class 2 or 3, ASA Ⅱ or Ⅲ, 45-75 years, body height 152-181 cm and weight of 43-78 kg, undergoing elective on pump CABG wererandomly divided into 2 groups： control group（ group C, n=11 ） and sevoflurane group （ group S, n = 15 ）. Pa- tients in group S inhaled sevoflurane with the end-tidal concentration equivalent to 1 MAC for 30 min, and then eluting for 30 rain. The MAP, HR, CVP, pulmonary artery occlusion pressure （PAOP） and TEE monitoring indicators including left ventricular ejection fraction （LVEF） and cardiac output （ CO）, stroke volumn（SV）, left ventricular global longitudinal strain（GLS） and left ventricular global circumferential strain（GCS） at the time point of before sternotomy （ To ）, 15 min after ceasing of CPB （T1）, inhalation of sevoflurane for 30 min （T2） and 30 min after eluting （T3） were recorded. Results Compared with the baseline value observed at To, HR at T1, T2 in groups S and HR at T1- T3 in group C were significantly higher. While HR at T2, T3 in group S were lower than that at To and group C （P〈0.01 or P〈0.05）. MAP at T2 in group S was significantly lower than that at To. MAP at T3 in group S was higher than that in group S compared with that at To. There was no statis- tical significance between CVP and PAOP in both groups. CO, SV and LVEF at T1 were higher than thost at To, while CO at T2, T3 in group C were significantly higher than those at To （P〈0.01 or P 〈0.05）. Compared with the baseline value observed at To, GLS at T1, T3 in group S were significantly higher and T1, T2 in group C were also higher. While GLS at Ta in group S was significantly higher than that at T2, but GLS at T3 was lower than T1 in group C. Compared with group C at Tz, GLS in group S was lower significantly（P〈0.01 or P〈0.05）. Compared with To, the GCS at T1, Ta in both groups were obviously higher. While GCS at T3 in group S was significantly higher than that at T2, but GCS was lower in group S than that in group C at T2 （P〈0.01 or P〈0.05）. Conclusion In patients undergoing elective on pump CABG, inhalation of sevoflurane （the end-tidal concentration equivalent to 1 MAC） can inhibit both longitudinal stain and circumferential strain of the left ventricular at the same time.