七氟醚不同处理方式在法洛氏四联症根治手术中对心肌肌钙蛋白的影响及心肌保护的临床分析

Different Ways to Deal With Sevoflurane in Tetralogy of Fallot Effects on Myocardial Troponin in Radical Surgery Clinical Observation of Myocardial Protection

目的比较七氟醚预处理和后处理在经体外循环下(CPB)法洛氏四联症(TOF)根治手术中对患者心肌保护的效果并比较两种方法的效果差异。方法选取行法洛氏四联症根治手术患者48例,采用随机数字表法,将其分为3组,对照组Ⅰ(n=16),2%七氟醚预处理组Ⅱ(n=16),2%七氟醚后处理组Ⅲ(n=16),其中对照组全程采取全凭静脉麻醉。采集手术切皮时,手术结束后6,12,24 h,测定患者血浆心肌肌钙蛋白I(c Tn I)的浓度,并记录主动脉阻断时间,体外循环时间,手术时间,ICU住院时间,机械通气时间,正性肌力药物使用情况。结果 3组患者一般资料、术中各指标比较差异无统计学意义(P>0.05)。各组手术切皮前血浆心肌肌钙蛋白I(c Tn I)(基础值)差异无统计学意义(P>0.05)。具有可比性,与1组比较,2组,3组在手术结束后4,12,24 h血浆心肌肌钙蛋白测定值降低,差异有统计学意义(P<0.05)。术后临床观察指标具有统计学意义(P<0.05)。2组3组在各时间点测定值差异无统计学意义(P>0.05)。结论在本研究条件下,以血浆心肌肌钙蛋白I(c Tn I)作为心肌保护的指标时,七氟醚缺血预处理组和七氟醚缺血后处理组均能显著降低心肌肌钙蛋白的浓度,减轻心肌缺血再灌注损伤,从而起到心肌保护作用,而两种处理方法在心肌保护方面未见明显差异。

Objective To compare sevoflurane preconditioning and postconditioning under the cardiopulmonary bypass（CPB） in the radical surgery for tetralogy of fallot（TOF） with myocardial protection effect and compare the effect of the two ways. Methods Selection method of 48 patients with disease of rockwell quadruple radical surgery, using the random number table method, it can be divided into three groups, control group Ⅰ（n=16）,Ⅱ 2%sevoflurane preconditioning group（n=16）,Ⅲ 2%sevoflurane postconditioning group（n = 16）, which controls the whole take all by intravenous anesthesia, acquisition operation cut leather, 6, 12, 24, hours after the surgery, the determination of serum cardiac troponin I（c Tn I） in patients with concentrations, and record the aorta block-ing time, extracorporeal circulation time, operation time, ICU length of hospital stay, mechanical ventilation time and positive in-otropic drug usage.Results three groups of patients＇ general information, comparison of the indexes in difference has no statistical significance（P〉0.05）.Before each operation cut skin serum cardiac troponin I（c Tn I）（base） no statistically significant difference（P〉0.05）.Comparable, compared with a group, two groups, three groups, 12, 24, 4 hours after the surgery plasma cardiac troponin mea-surements is reduced, statistically significant（P〈0.05）.The postoperative clinical observation indexes statistically significant（P〈0.05）.Two groups of three groups there was no evident difference in the determination of each time point, not statistically signifi-cant（P〉0.05）.Conclusion Under the condition of this study, the serum cardiac troponin I（c Tn I） as the index of myocardial protection, sevoflurane ischemia preconditioning group and sevoflurane postconditioning group can significantly reduce the myocardial troponin concentrations, alleviate myocardial ischemia-reperfusion injury, thus play a role of myocardial protection, two processing methods and no obvious difference in myocardial protection.