麻醉因素与体外循环心脏手术患者肠损伤的关系：异丙酚复合麻醉与七氟醚复合麻醉的比较

Relationship between anesthetic factor and intestinal injury in patients undergoing cardiac surgery with cardiopulmonary bypass： a comparison of propofol-versus sevoflurane-based anesthesia

目的 探讨麻醉因素与体外循环心脏手术患者肠损伤的关系.方法 择期行体外循环下心脏手术患者90例,年龄18～64岁,性别不限,ASA分级Ⅱ或Ⅲ级,NYHA分级Ⅱ或Ⅲ级,采用随机数字法分为2组（n=45）：异丙酚复合麻醉组（P组）和七氟醚复合麻醉组（S组）,采用相应常规麻醉方法,常规建立体外循环.分别于麻醉诱导前（T0）、主动脉开放即刻（T1）、主动脉开放30 min（T2）、CPB结束后2 h（T3）时采集桡动脉血样,采用ELISA法检测血浆内毒素、D-乳酸、二胺氧化酶（DAO）及肠脂肪酸结合蛋白（Ⅰ-FABP）的浓度,采用放射免疫法测定血浆IL-6、IL-8和TNF-α的浓度.结果 与T0时比较,2组T1～T3时血浆内毒素、D-乳酸、DAO、TNF-α、IL-6、IL-8及I-FABP浓度升高（P＜0.05）.与P组比较,S组T1～T3时血浆内毒素、D-乳酸、DAO、TNF-α、IL-6、IL-8及I-FABP浓度降低（P＜0.05）.结论 麻醉因素与体外循环心脏手术患者肠损伤程度有关.与异丙酚复合麻醉比较,七氟醚复合麻醉有助于减轻炎症反应而降低肠损伤程度,更适于体外循环心脏手术.

Objective To investigate the relationship between anesthetic factors and intestinal injury in the patients undergoing elective cardiac surgery with cardiopulmonary bypass （CPB）.Methods Ninety American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes,aged 18-64 yr,with New York Heart Association grade Ⅱ or Ⅲ,undergoing elective cardiac surgery with CPB,were divided into 2 groups （n =45 each） using a random number table：propofol-based anesthesia group （group P） and sevoflurane-based anesthesia group （group S）.CPB was established routinely after anesthesia induction.Before induction （T0）,immediately after aortic unclamping （T1）,at 30 min after aortic unclamping （T2） and at 2 h after discontinuation of CPB （T3）,blood samples were collected from the radial artery for determination of the plasma endotoxin,D-lactic acid,diamine oxidase （DAO） and intestinal fatty acid-binding protein （Ⅰ-FABP） concentrations （by enzyme-linked immunosorbent assay） and plasma interleukin-6 （IL-6）,IL-8 and tumor necrosis factor-alpha （TNF-o） concentrations （using radio-immunity method）.Results Compared with the baseline at T0,the concentrations of plasma endotoxin,D-lactic acid,DAO,TNF-α,IL-6,IL-8 and I-FABP were significantly increased at T1-T3 in both groups （P〈0.05）.Compared with group P,the concentrations of plasma endotoxin,D-lactic acid,DAO,TNF-α,IL-6,IL-8 and I-FABP were significantly decreased at T1-T3 in group S （P〈0.05）.Conclusion Anesthetic factors are related to intestinal injury in patients undergoing cardiac surgery with CPB.Compared with propofol-based anesthesia,sevoflurane-based anesthesia is helpful in reducing the inflammatory response and in decreasing the degree of intestinal injury and is more suitable for the cardiac surgery with CPB.