地氟醚与咪唑安定或异丙酚联合应用对心肺转流心内直视手术心肌损伤的保护作用

Protective effects of combination of desflurane and propofol or midazol-am against myocardial injury in patients undergoing open heart surgery

目的 观察地氟醚与咪唑安定或异丙酚联合应用对心肺转流 (CPB)心内直视手术心肌损伤的保护作用。方法 5 0例先天性心脏病房、室间隔缺损择期行心内直视手术患者 ,随机分为 5组 :咪唑安定组 (Ⅰ组 )、异丙酚组 (Ⅱ组 )、地氟醚组 (Ⅲ组 )、地氟醚加咪唑安定组 (Ⅳ组 )和地氟醚加异丙酚组 (Ⅴ组 ) ,每组 10例。Ⅰ组用微泵静注咪唑安定 0 2～ 0 4mg·kg-1·h-1;Ⅱ组微泵静注异丙酚 2 0～ 4 0mg·kg-1·h-1,Ⅲ组CPB前、主动脉开放后吸入 1 0MAC地氟醚 ;Ⅳ组CPB前吸入地氟醚同Ⅲ组 ,主动脉阻断后微泵静注咪唑安定同Ⅰ组 ;Ⅴ组CPB前吸入地氟醚同Ⅲ组 ,主动脉阻断后微泵静注异丙酚同Ⅱ组。分别在术前、停CPB后 30min、2h和 2 4h取中心静脉血 ,测定血清心肌肌钙蛋白 (cTnⅠ )水平 ,并观察开放主动脉后心脏复跳情况。结果 与术前比较 ,5组患者停CPB后各时点cTnⅠ明显升高 (P <0 0 1)。Ⅰ组与其它各组比较升高更明显 (P <0 0 1) ;Ⅱ组在停CPB后 30min、2h升高 ,与Ⅲ组同时点比较差异显著(P <0 0 5 ) ;Ⅳ组、Ⅴ组与Ⅲ组同时点值比较 ,血清cTnⅠ未见明显降低 ;Ⅳ组与Ⅴ组相比差异无显著性 (P >0 0 5 )。各组心脏自动复跳率差异无显著性。结论 异丙酚减轻心肌缺血再灌注损伤的作用明显强于等效剂量的咪?

Objective To observe the cardioprotective e ffects of midazolam, propofol, desflurane and desflurane combined with propofol or midazolam anesthesia on myocardial injury during open heart surgery. Methods Fifty patients, scheduled for open heart surgery, were randomly divided into midazolam group(Ⅰ),propofol group (Ⅱ),desflurane group (Ⅲ), desflurane combined with midazolam group(Ⅳ) and desflurane combined with propofol group(Ⅴ).Midazolam (0 2～0 4 mg·kg -1 ·h -1 ) infusion was given to group Ⅰ and group Ⅳ after clamping of aorta. Propofol(2 0～4 0 mg·kg -1 ·h -1 ) infusion was given to group Ⅱ and group Ⅴ after clamping of aorta. And desflurane (1 0 MAC) inhalation was given to group Ⅲ,Ⅳ and Ⅴ before cardiopulmonary byposs(CPB) and after claping of aorta. The central venous blood samples were collected to measure the serum levels of cardiac troponin Ⅰ(cTnⅠ) before operation and 30 min,2 h and 24 h after weaning of CPB. Rate o f spontanous heart rebeating was observed after reperfusion. Results The levels of serum cTnⅠ increased significantly in five groups after weaning of CPB ( P <0 01). The serum cTnⅠ level in group Ⅰ was significantly higher than those in the other groups ( P <0 01). The difference in serum cTnⅠ levels between group Ⅲ and groups Ⅳ and Ⅴ was of no statistical significance. Rate of spontanous heart rebeating in all groups were similar after reperfusion. Conclusion Desflurane can reduce myocardial injury. Propofol is significantly effective than midazolam of equivalent dose. Combination of desflurane with prorofol or midazolam does not enhance its cardioprotective effects.