七氟醚与丙泊酚对心脏瓣膜置换术心肌缺血再灌注损伤的影响

Effect of sevoflurane and propofol on myocardial ischemia reperfusion injury in patients undergoing cardiac valve replacement

目的:探讨七氟醚与丙泊酚对心脏瓣膜置换术心肌缺血再灌注损伤的影响。方法:将70例二尖瓣置换术的风湿性心脏病患者随机分为七氟醚组和丙泊酚组,记录两组患者不同时间点的心率、平均动脉压及中心静脉压,对心肌肌钙蛋白I(c Tn I)水平、超氧化物歧化酶(SOD)活性及丙二醛(MDA)水平进行检测,对术中、术后住院指标进行比较。结果:(1)两组患者术前(T0)、体外循环前(T1)、体外循环后(T2)及术毕时(T3)的心率、平均动脉压及中心静脉压比较,差异均无统计学意义(P>0.05)。(2)七氟醚组在主动脉开放2 h(t1)、6 h(t2)及24 h(t3)c Tn I、MDA水平均明显低于丙泊酚组(P<0.05);七氟醚组在t1、t2及t3时间点的SOD活性均明显高于丙泊酚组(P<0.05)。(3)七氟醚组气管导管拔出时间及ICU停留时间均明显短于丙泊酚组(P<0.05)。结论:七氟醚麻醉可明显减轻行二尖瓣置换术风湿性心脏病患者的心肌缺血再灌注损伤,值得临床推广与应用。

Objective： To explore effect of sevoflurane and propofol on myocardial ischemia reperfusion injury in patients undergoing cardiac valve replacement. Methods： Seventy patients with rheumatic heart disease who received mitral valve replacement were randomly divided into sevoflurane group and propofol group. HR,MAP and CVP were record,the level of c Tn I,MDA and the activity of SOD were detected at different time. Postoperative hospitalization index in two groups were compared. Results：（ 1） There were no significant differences between two groups of HR,MAP and CVP before operation（ T0）,before cardiopulmonary bypass（ T1）,after cardiopulmonary bypass（ T2） and after operation（ T3）（ P〉0. 05）.（ 2） The levels of c Tn I and MDA in sevoflurane group were significantly lower than those in propofol group at two hours（ t1）,six hours（ t2）,and twenty-four hours（ t3）（ all P〈0. 05）. The activity of SOD in sevoflurane group were significantly higher than those in propofol group at t1,t2 and t3（ P〈0. 05）.（ 3） Tracheal extubation time and duration of hospitalization in ICU in sevoflurane group were significantly shorter than those in propofol group（ P〈0. 05）. Conclusion： Sevoflurane anesthesia can reduce myocardial ischemia reperfusion injury in patient with rheumatic heart disease who will receive mitral valve replacement. It is worthy of wide spread application in clinical practice.