七氟烷后处理可减轻对小儿体外循环心肌缺血再灌注损伤

Attenuation Effect of Sevoflurane Postconditioning on Myocardial Ischemia-Reperfusion Injury in Pediatric Cardiopulmonary Bypass

探讨七氟烷后处理对小儿体外循环（CPB）下心肌缺血再灌注损伤（MIRI）的保护作用。选择68例CPB心房室间隔缺损修复术患儿,随机分为对照组和治疗组,对照组不使用任何吸入性麻醉药,治疗组在主动脉开放即刻输入2%七氟烷,持续15 min。比较两组中主动脉阻断时间、CPB时间和多巴胺使用量以及术后患者自动复跳例数和ICU时间的差异。分别于诱导手术前（T0）、主动脉开放（T1）、主动脉开放后1h（T2）、6h（T3）和24h（T4）采集静脉血，检测两组血浆心肌肌钙蛋白I（cTnI）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）浓度；与手术前，术后1h、6h和20h取外周血，检测两组血浆中肿瘤坏死因子-α（TNF-α）和白介素-6（IL-6）的水平。两组患者在术中情况和手术结局方面无显著性差异（p〉0．05）；治疗组cTnI、CK和CK-MB浓度在T2-T4时明显低于对照组（p〈0．05）；治疗组术后1h、6h和24h血浆中TNF-α和IL-6的水平明显低于对照组（p〈0．05）。七氟烷后处理不会改变小儿CPB下心脏手术的手术进程和术后结局，可以减轻心肌缺血再灌注损伤并抑制全身炎症反应。

This research was aimed to investigate the protective effect of sevoflurane postconditioning on myocardial ischemia-reperfusion injury （MIRI） in pediatric cardiopulmonary bypass （CPB）. In this study, 68 children with CPB atrioventricular septal defect repair were randomly divided into control group and treatment group. In the control group, no inhaled anesthetics were used. In the treatment group, 2% sevoflurane was infused immediately after the aorta was opened, lasting for 15 minutes. The aorta occlusion time, CPB time, dopamine usage as well as the number of patients with spontaneous repercussion and ICU time in two groups were compared. Venous blood was collected before induction of surgery （To）, when aortic opening （T1）, at 1 h （T2）, 6 h （T3） and 24 h （T4） after aortic opening, and plasma cardiac troponin I （cTnI）, creatine kinase （CK） and creatine kinase （CK-MB） were measured in two groups. Peripheral blood was collected before surgery and at 1 h, 6 h, 24 h after surgery, then tumor necrosis factor-α （TNF-α） and interleukin-6 （IL-6） levels were measured in two groups. There was no significant difference between the two groups in terms ofintraoperative status and surgical outcome （p〉0.05）. The concentrations ofcTnI, CK and CK-MB in the treatment group were significantly lower than those in the control group at T2-T4 （p〈0.05） The levels of TNF-α and IL-6 in plasma at 1 h, 6 h and 24 h after surgery in the treatment group were significantly lower than those in the control group （p〈0.05）. Sevoflurane postconditioning could not change the surgical procedure and postoperative outcome of cardiac surgery in pediatric CPB, as well as reduce myocardial ischemia-reperfusion injury and inhibit systemic inflammatory response.