全程吸入不同浓度七氟烷对冠状动脉旁路移植术患者心肌保护作用及炎症细胞因子的影响

Effects of Inhalation of Different Concentrations of Sevoflurane on Myocardial Protection and Inflammatory Cytokines in Patients Undergoing Coronary Artery Bypass Grafting

目的研究全程吸入不同浓度七氟烷对冠状动脉旁路移植术患者心肌保护作用及炎症细胞因子的影响。方法选取2020年7月-2021年7月我院诊治的66例的冠状动脉旁路移植术患者为研究对象,采用随机数字表法分为对照组和观察组,各33例。观察组持续吸入1.0%~2.0%浓度七氟烷,对照组持续吸入2.1%~3.0%浓度七氟烷,比较两组不同时间点(麻醉诱导时、插管即刻、拔管即刻)心肌指标、血流动力学指标、炎症细胞因子水平、麻醉质量以及心血管不良事件发生率。结果观察组拔管即刻hs-cTnT、hs-CRP水平均低于对照组(P<0.05);两组拔管即刻SBP、DBP、HR均低于麻醉诱导时,且观察组高于对照组(P<0.05);两组拔管即刻IL-8水平高于麻醉诱导时,IL-10水平低于麻醉诱导时,且观察组IL-8水平低于对照组,IL-10水平高于对照组(P<0.05);观察组镇静评分、平面维持时间与对照组比较,差异无统计学意义(P>0.05);观察组低血压、心动过速、心肌缺血、期前收缩、房颤发生率均低于对照组(P<0.05)。结论对冠状动脉旁路移植术患者全程吸入低浓度七氟烷,可实现良好的麻醉效果,降低心血管不良事件,减轻炎症细胞因子,保护心肌细胞,具有相对更优的应用安全性。

Objective To study the effects of different concentrations of sevoflurane inhalation on myocardial protection and inflammatory cytokines in patients undergoing coronary artery bypass grafting.Methods From July 2020 to July 2021,66 patients with coronary artery bypass grafting in our hospital were selected as the research objects.They were divided into control group and observation group by random number table method,with 33 cases in each group.The observation group continued to inhale 1.0%-2.0%sevoflurane,and the control group continued to inhale 2.1%-3.0%sevoflurane.The myocardial indexes at different time points(anesthesia induction,intubation immediately,extubation immediately),hemodynamic indexes,inflammatory cytokine levels,anesthesia quality and incidence of cardiovascular adverse events were compared between the two groups.Results The levels of hs-cTnT and hs-CRP in the observation group were lower than those in the control group immediately after extubation(P<0.05).The SBP,DBP and HR of the two groups immediately after extubation were lower than those during anesthesia induction,and the observation group was higher than the control group(P<0.05).The level of IL-8 at the time of extubation in the two groups was higher than that during anesthesia induction,and the level of IL-10 was lower than that during anesthesia induction,the level of IL-8 in the observation group was lower than that in the control group,and the level of IL-10 was higher than that in the control group(P<0.05).There was no significant difference in sedation score and plane maintenance time between the observation group and the control group(P>0.05).The incidences of hypotension,tachycardia,myocardial ischemia,premature contraction and atrial fibrillation in the observation group were lower than those in the control group(P<0.05).Conclusion Inhalation of low concentration sevoflurane in patients undergoing coronary artery bypass grafting can achieve good anesthetic effect,reduce cardiovascular adverse events,reduce inflammatory cytokines and protect myocardial cells,with relatively better application safety.