麻醉因素与体外循环心脏手术患者心肌损伤的关系：右美托咪定复合七氟醚麻醉

Relationship between anesthesia factor and myocardial injury in patients undergoing cardiac surgery with cardiopulmonary bypass： dexmedetomidine combined with sevoflurane anesthesia

目的 评价麻醉因素与体外循环（CPB）心脏手术患者心肌损伤的关系。方法 择期CPB下行冠脉搭桥术患者88例，性别不限，年龄42～71岁，体重59～83 kg，ASA分级Ⅱ或Ⅲ级，NYHA分级Ⅱ或Ⅲ级，采用随机数字表法分为4组（n＝22）：常规麻醉组（C组）、右美托咪定复合麻醉组（D组）、七氟醚复合麻醉组（S组）和右美托咪定复合七氟醚麻醉组（DS组）。S组和DS组于气管插管后吸入0.2%～2.1%七氟醚至CPB开始；D组与DS组于麻醉诱导前经10 min静脉输注右美托咪定负荷剂量1 μg/kg，而后以0.4 μg·kg－1·h－1速率输注至手术结束。于麻醉诱导前、CPB前、CPB结束后、术毕即刻及术后24 h时采取静脉血标本，采用免疫荧光法检测血浆CK-MB及cTnI的浓度。记录心脏自动复跳情况，术中及术后24 h内低血压、恶性心律失常、心搏骤停及呼吸抑制等不良事件的发生情况。结果 与C组比较，其它3组血浆CK-MB及cTnI浓度降低（P〈0.05）；与S组和D组比较，DS组血浆CK-MB及cTnI浓度降低（P〈0.05）。4组心脏自动复跳率比较差异无统计学意义（P〉0.05）。4组患者术中及术后24 h均未见不良事件发生。结论 右美托咪定复合七氟醚麻醉有助于减轻CPB心脏手术患者心肌损伤程度，且效果优于两者单独复合麻醉，更适于CPB心脏手术。

Objective To evaluate the relationship between the anesthesia factor and myocardial injury in the patients undergoing cardiac surgery with cardiopulmonary bypass（CPB）.Methods Eighty-eight patients of both sexes, aged 42-71 yr, weighing 59-83 kg, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ（New York Heart Association Ⅱ or Ⅲ）, scheduled for elective coronary artery bypass grafting with CPB, were divided into 4 groups（n=22 each）using a random number table： routine anesthesia control group（group C）, dexmedetomidine-based anesthesia group（group D）, sevoflurane-based anesthesia group（group S）and dexmedetomidine combined with sevoflurane anesthesia group（group DS）. After tracheal intubation, 0.2%-2.1% sevoflurane was inhaled until the beginning of CPB in S and DS groups.In D and DS groups, dexmedetomidine was intravenously infused as a loading dose of 1 μg/kg over 10 min before induction of anesthesia, followed by an infusion of 0.4 μg·kg-1·h-1 until the end of surgery.Before induction of anesthesia, before CPB, after the end of CPB, immediately after the end of surgery and at 24 h after surgery, venous blood samples were collected for determination of plasma creatine kinase-MB（CK-MB）and cardiac troponin I（cTnI）concentrations by immunofluorescence.The restoration of spontaneous heart beat and adverse events such as hypotension, malignant arrhythmia, cardiac arrest and respiratory depression during surgery and within 24 h after surgery were recorded.Results Compared with group C, the plasma concentrations of CK-MB and cTnI were significantly decreased in the other three groups（P〈0.05）. The plasma concentrations of CK-MB and cTnI were significantly lower in group DS than in S and D groups（P〈0.05）. There were no significant differences in the rate of restoration of spontaneous heart beat among the four groups（P〉 0.05）. No adverse events were found during surgery and within 24 h after surgery in the four groups.Conclusion Dexmedetomidine combined with sevoflurane anesthesia is helpful in reducing myocardial injury and provides better efficacy than either alone in the patients undergoing cardiac surgery with CPB and is more suitable for cardiac surgery with CPB.