异丙酚对2型糖尿病患者冠状动脉旁路移植术前与术后心肌损伤程度及其心功能的影响

Effect of propofol intravenous on myocardial damage degree and cardiac function for 2 diabetes patients before and after coronary artery bypass grafting

目的研究异丙酚对2型糖尿病患者冠状动脉旁路移植术(CABG)前后心肌损伤程度和心功能的影响。方法入选76例2型糖尿病患者,根据随机数字法分为试验组和对照组,每组38例。2组患者均采取常规麻醉诱导后,试验组以输注异丙酚1~2μg·kg^(-1)·m L^(-1)维持麻醉,同时持续静脉输注0.2~0.4μg·kg^(-1)·min^(-1)瑞芬太尼;对照组吸入异氟烷和静脉输注0.2~0.4μg·kg^(-1)·min^(-1)瑞芬太尼。于手术前和术后12 h,测定2组患者的丙二醛(MDA)、超氧化物歧化酶(SOD)、缺血修饰白蛋白(IMA)及肌钙蛋白I(c Tn I)水平。结果手术前,与对照组的MDA、SOD、IMA、c Tn I水平分别为(3.62±0.37)nmol·L^(-1)、(72.36±8.22)nmol·L^(-1)、(77.61±3.74)ABSU·m L^(-1)、(0.07±0.01)μg·L^(-1)比较,试验组的这4个指标水平分别为(3.69±0.43)nmol·L^(-1)、(73.24±6.13)nmol·L^(-1)、(77.29±3.94)ABSU·m L^(-1)、(0.08±0.02)μg·L^(-1),2组差异无统计学意义(P>0.05)。手术后12 h,试验组的MDA、IMA及c Tn I水平分别为(4.42±0.82)nmol·L^(-1)、(70.52±2.62)ABSU·m L^(-1)、(3.70±0.28)μg·L^(-1),显著低于对照组的(7.14±1.01)nmol·L^(-1)、(73.63±4.12)ABSU·m L^(-1)、(4.79±0.29)μg·L^(-1);而试验组SOD为(68.74±6.82)nmol·L^(-1),显著高于对照组的(64.01±5.88)nmol·L^(-1),2组差异均有统计学意义(均P<0.05)。结论在2型糖尿病患者中进行CABG手术时,相对于异氟烷,使用静脉麻醉药异丙酚能有效降低患者心肌损伤程度,更能有效地保护心功能。

Objective To study the effect of propofol intravenous on myocardial damage degree and cardiac function for 2 diabetes patients before and after coronary artery bypass grafting. Methods Seventy - six patients with type 2 diabetes in our hospital was selected from April 2014 to October 2015. The patients were divided into treatment group and control group, according to the method of random numbers,38 cases in each group. Patients in two groups were taken general anesthesia induction, treatment group were infused 1 -2μg·kg^-1·min^-1 propofol after anes- thesia induction to maintain anesthesia, continuous intravenous infusion of 0.2 - 0.4μg·kg^-1·min^-1 fentanyl. Patients in control group isoflu- rane inhalation and intravenous 0.2 -0.4 μg·kg^-1·min^-1 fentanyl. Before surgery and postoperative 12 h, the level of the malondialdehyde （MDA）, superoxide dismutase （SOD）, isehemia modified albumin （ IMA）, troponin [ （cardiac troponin I, cTnI） in two groups were measured by spectrophotometer . Results Before the operation, the level of MDA, SOD, IMA, cTnIin the treatment group were （3.69 ±0.43） nmol·L^-1, （73.24 ±6.13） nmol·L^-1, （77.29± 3.94） ABSU·mL^-1, （ 0. 08 ± 0. 02 ） μg· L^-1, respectively while in control group were （ 3.62 ± 0. 37 ） nmol·L^-1, （72.36 ±8.22） nmol·L^-1 , （77.61 ± 3.74） ABSU·mL^-1 , （0.07 ± 0.01 ） μg·L^-1 with no significant difference （P〉0.05）. After 12 h of operation , the level of MDA, IMA, cTnI in treatment group were （4.42 ± 0.82） nmol· L^-1, （70. 52 ± 2. 62） ABSU· mL^-1, （ 3.70 ± 0. 28 ） μg· L^-1, significantly lower than control group with （7. 14 ± 1.01 ） nmol·L^-1, （73.63 ± 4. 12 ） ABSU·mL^-1, （4. 79 ± 0. 29 ）μg ·L^-1. But SOD in treatment group was （ 68.74 ± 6. 82） nmol· L^-1, significantly higher than the control group with （ 64. 01±5.88 ） nmol·L^-1, the difference between two groups above factors had statistical significance （all P 〈 0. 05 ） . Conclusion Patients with type 2 diabetes using CABG surgery, the use of intravenous propofol, compared with isoflurane, can effectively reduce the degree of myocardial injury and effectively protect the cardiac function in patients.