咪达唑仑、七氟烷和丙泊酚麻醉对心脏手术患者心肌氧化损伤的影响

Effects of midazolam,sevoflurane and propofol anesthesia on myocardial oxidative damage in patients with cardiac surgery

目的分析咪达唑仑、七氟烷和丙泊酚不同麻醉药物对心脏手术患者心肌氧化损伤的影响。方法63例行心脏手术患者,随机分为A组、B组、C组,每组21例。A组给予咪达唑仑麻醉,B组给予七氟烷麻醉,C组给予丙泊酚麻醉。比较三组术前(T1)、动脉开放30 min(T2)、动脉开放1 h(T3)时刻心肌损伤指标[肌酸激酶(CK)、乳酸脱氢酶(LDH)、心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)]和氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)]水平。结果A组患者T1时CK为(86.34±6.32)U/L、LDH为(177.32±13.98)U/L、cTnI为(0.49±0.17)mg/L、CK-MB为(18.48±3.18)U/L,T2时CK为(292.12±17.99)U/L、LDH为(334.87±43.68)U/L、cTnI为(170.68±18.47)mg/L、CK-MB为(88.74±7.46)U/L,T3时CK为(490.78±32.00)U/L、LDH为(559.48±65.49)U/L、cTnI为(150.68±9.98)mg/L、CK-MB为(43.32±6.12)U/L;B组患者T1时CK为(89.32±6.41)U/L、LDH为(175.43±13.98)U/L、cTnI为(0.49±0.06)mg/L、CK-MB为(18.32±2.48)U/L,T2时CK为(140.32±10.57)U/L、LDH为(264.32±22.48)U/L、cTnI为(52.13±5.92)mg/L、CK-MB为(34.98±2.78)U/L,T3时CK为(271.18±19.87)U/L、LDH为(325.78±27.69)U/L、cTnI为(16.12±1.93)mg/L、CK-MB为(28.17±3.73)U/L;C组患者T1时CK为(86.98±5.84)U/L、LDH为(175.74±15.12)U/L、cTnI为(0.50±0.08)mg/L、CK-MB为(18.28±2.68)U/L,T2时CK为(142.18±11.28)U/L、LDH为(259.63±18.87)U/L、cTnI为(49.12±4.98)mg/L、CK-MB为(33.13±2.72)U/L,T3时CK为(264.58±18.48)U/L、LDH为(330.48±29.35)U/L、cTnI为(14.38±1.66)mg/L、CK-MB为(27.76±3.28)U/L。T1时,三组患者CK、LDH、cTnI、CK-MB水平比较,差异均无统计学意义(P>0.05)。T2、T3时,三组CK、LDH、cTnI、CK-MB水平均高于T1,且B组、C组的CK、LDH、cTnI、CK-MB水平均低于A组,差异均具有统计学意义(P<0.05)。T1时,A组MDA为(9.46±0.22)mmol/L、B组MDA为(9.46±0.22)mmol/L、C组MDA为(9.42±0.21)mmol/L,三组比较差异无统计学意义(P>0.05);T2时,B组患者MDA(11.56±0.19)mmol/L、C组患者MDA(11.12±0.44)mmol/L低于A组的(17.68±0.24)mmol/L,差异均具有统计学意义(P<0.05);T3时,B组患者MDA(10.62±0.23)mmol/L、C组患者MDA(10.87±0.22)mmol/L均低于A组的(12.87±0.22)mmol/L,差异均具有统计学意义(P<0.05)。T1时,A组患者SOD为(89.58±5.48)U/L、B组患者SOD为(89.74±5.32)U/L、C组患者SOD为(89.33±5.28)U/L,三组比较差异无统计学意义(P>0.05);T2时,B组患者SOD水平(45.32±3.29)U/L、C组患者SOD水平(48.83±3.48)U/L均高于A组的(25.62±3.28)U/L,差异均具有统计学意义(P<0.05);T3时,B组患者SOD水平(80.99±3.79)U/L、C组患者SOD水平(79.87±2.49)U/L均高于A组的(77.65±2.87)U/L,差异均具有统计学意义(P<0.05)。结论给予行心脏手术的患者七氟烷和丙泊酚麻醉效果显著,可预防患者心肌受损,具有推广应用价值。

Objective To analyze the effects of midazolam,sevoflurane and propofol anesthesia on myocardial oxidative damage in patients with cardiac surgery.Methods A total of 63 patients undergoing cardiac surgery were randomly divided into group A,group B,and group C,with 21 cases in each group.Group A received midazolam anesthesia,group B received sevoflurane anesthesia,and group C received propofol anesthesia.Comparison was made on myocardial injury indexes[creatine kinase(CK),lactate dehydrogenase(LDH),cardiac troponin I(cTnI),phosphocreatine kinase isoenzyme(CK-MB)]and oxidative stress indicators[malondialdehyde(MDA),superoxide dismutase(SOD)]levels before surgery(T1),arterial opening for 30 min(T2),arterial opening for 1 h(T3)among the three groups.Results In group A,at T1,CK was(86.34±6.32)U/L,LDH was(177.32±13.98)U/L,cTnI was(0.49±0.17)mg/L,and CK-MB was(18.48±3.18)U/L;at T2,CK was(292.12±17.99)U/L,LDH was(334.87±43.68)U/L,cTnI was(170.68±18.47)mg/L,and CK-MB was(88.74±7.46)U/L;at T3,CK was(490.78±32.00)U/L,LDH was(559.48±65.49)U/L,cTnI was(150.68±9.98)mg/L,and CK-MB was(43.32±6.12)U/L.In group B,at T1,CK was(89.32±6.41)U/L,LDH was(175.43±13.98)U/L,cTnI was(0.49±0.06)mg/L,and CK-MB was(18.32±2.48)U/L;at T2,CK was(140.32±10.57)U/L,LDH was(264.32±22.48)U/L,cTnI was(52.13±5.92)mg/L,and CK-MB was(34.98±2.78)U/L;at T3,CK was(271.18±19.87)U/L,LDH was(325.78±27.69)U/L,cTnI was(16.12±1.93)mg/L,and CK-MB was(28.17±3.73)U/L.In group C,at T1,CK was(86.98±5.84)U/L,LDH was(175.74±15.12)U/L,cTnI was(0.50±0.08)mg/L,and CK-MB was(18.28±2.68)U/L;at T2,CK was(142.18±11.28)U/L,LDH was(259.63±18.87)U/L,cTnI was(49.12±4.98)mg/L,and CK-MB was(33.13±2.72)U/L;at T3,CK was(264.58±18.48)U/L,LDH was(330.48±29.35)U/L,cTnI was(14.38±1.66)mg/L,and CK-MB was(27.76±3.28)U/L.At T1,there was no statistically significant difference in the levels of CK,LDH,cTnI and CK-MB among the three groups(P>0.05).At T2 and T3,the levels of CK,LDH,cTnI,and CKMB in the three groups were higher than those at T1,and the levels of CK,LDH,cTnI,and CK-MB in group B and group C were lower than those in group A.The differences were all statistically significant(P<0.05).At T1,the MDA in group A was(9.46±0.22)mmol/L,the MDA in group B was(9.46±0.22)mmol/L,and the MDA in group C was(9.42±0.21)mmol/L,and the difference was not statistically significant among the three groups(P>0.05).At T2,MDA in group B was(11.56±0.19)mmol/L,and MDA in group C was(11.12±0.44)mmol/L,which were lower than(17.68±0.24)mmol/L in group A,and the difference was statistically significant(P<0.05).At T3,MDA in group B was(10.62±0.23)mmol/L,and MDA in group C was(10.87±0.22)mmol/L,which were lower than(12.87±0.22)mmol/L in group A;the differences were all statistically significant(P<0.05).At T1,the SOD in group A was(89.58±5.48)U/L,the SOD in group B was(89.74±5.32)U/L,and the SOD in group C was(89.33±5.28)U/L,and the difference was not statistically significant among the three groups(P>0.05).At T2,SOD in group B was(45.32±3.29)U/L,and SOD in group C was(48.83±3.48)U/L,which were higher than(25.62±3.28)U/L in group A,and the difference was statistically significant(P<0.05).At T3,SOD of group B was(80.99±3.79)U/L,and SOD of group C was(79.87±2.49)U/L,which were higher than(77.65±2.87)U/L in group A;the differences were all statistically significant(P<0.05).Conclusion Sevoflurane and propofol anesthesia has significant effect on patients with cardiac surgery,which can prevent myocardial damage and has the value of popularization and application.