七氟醚预处理在婴幼儿体外循环心肌再灌注损伤中的应用研究

Sevoflurane Preconditioning in Cardiomyocardial Reperfusion Injury after Cardiopulmonary Bypass in Infants

目的:探讨七氟醚预处理在婴幼儿体外循环心肌再灌注损伤中的临床应用效果及作用机制。方法:选取2015年10月至2017年4月医院收治的需行手术治疗的室间隔缺损婴幼儿50例,按随机数表法分为对照组和观察组各25例,对照组患儿气管插管后吸入空气-氧气混合体,观察组患儿气管插管后吸入七氟醚,10 m洗脱,保证主动脉阻断前七氟醚吸入浓度为0。利用分光光度计、酶标仪测定丙二醛(MDA)、超氧化物歧化酶(SOD)及过氧化物酶(CTA)水平,采用全自动微粒子化学发光仪检测诱导后、主动脉开放6 h后两组患儿血浆心肌肌钙蛋白Ⅰ(cTnⅠ)、肌红蛋白(Mb)及肌酸激酶同工酶(CK-MB)水平,比较两组患儿的临床疗效。结果:观察组患儿主动脉开放30 min后MDA水平低于对照组(P<0.05);观察组患儿主动脉开放30 min后SOD及CTA水平均高于对照组(P <0.05);观察组患儿主动脉开放30 min后cTnⅠ、Mb及CK-MB水平均低于对照组(P <0.05);观察组患儿麻醉后并发症发生率(12.00%)与对照组(8.00%)比较差异无统计学意义(P> 0.05)。结论:室间隔缺损婴幼儿围术期应用七氟醚预处理的临床效果理想,能减轻患儿体外循环心肌再灌注损伤,减少氧自由基的生成,值得推广应用。

Objective:To investigate the clinical application and mechanism of sevoflurane preconditioning in cardiomyocardial reperfusion injury after cardiopulmonary bypass in infants.Methods:Fifty infants with ventricular septal defect admitted into the hospital from Oct.2015 to Apr.2017 were extracted to be divided into the control group and the observation group via the random number table,with 25 cases in each group.The control group inhaled the air-oxygen mixture after endotracheal intubation,and the observation group inhaled sevoflurane after endotracheal intubation,followed by 10 m elution,ensuring that the concentration of sevoflurane inhaled before aortic occlusion was 0.The levels of malondialdehyde(MDA),superoxide dismutase(SOD)and peroxidase(CTA)were measured by spectrophotometer and microplate reader.The automatic microparticle chemiluminescence was used to detect the induction and aortic opening for 6 h.The levels of plasma cardiac troponinⅠ(cTnⅠ),myoglobin(Mb)and creatine kinase isoenzyme(CK-MB)were compared between two groups,and the clinical efficacy of two groups was compared.Results:The MDA level of the observation group was lower than that of the control group after aorta opening of 30 min(P<0.05).The SOD and CTA levels in the observation group were higher than those in the control group after aorta opening of 30 min(P<0.05).The cTnⅠ,Mb and CK-MB levels in the observation group were all lower than those in the control group after aorta opening of 30 min(P<0.05).There was no significant difference in the incidence of postanesthesia complications between the observation group(12.00%)and the control group(8.00%,P>0.05).Conclusion:The clinical effect of sevoflurane pretreatment in the perioperative period of infants with ventricular septal defect is remarkable,which can relief the myocardial reperfusion injury after cardiopulmonary bypass in infants and reduce the generation of oxygen free radicals,and is worthy of promotion and application.