安氟醚对体外循环下心内直视手术心肌缺血再灌注损伤的影响

Effects of enflurane on myocardial reperfusion injury during cardiac surgery with cardiopulmonary bypass

目的 :研究安氟醚对体外循环心内直视手术期间心肌缺血再灌注损伤的影响。方法 :选择择期行心瓣膜置换的风湿性心脏病患者 30例 ,随机分为 3组 , 组、 组在主动脉阻断前分别吸入 1.0 MAC、0 .5 MAC的安氟醚 , 组为对照组静脉给芬尼太。在围术期不同时点作血肌酸磷酸激酶 (CK- MB)、脂质过氧化产物 (MDA)、超氧化物歧化酶 (SOD)测定。结果 :3组患者 CK- MB、MDA、SOD值均于主动脉开放即刻升高 ,与麻醉前、缺血前比较差异有显著性 (P均 <0 .0 5 ) ,于主动脉开放后 10、30 min达最大值 ,并高于主动脉开放即刻 (P<0 .0 5 ) ,术后 2 4 h虽低于主动脉开放 10 min时 (P<0 .0 5 ) ,但仍高于麻醉前。在主动脉开放即刻、10 min, 组患者 CK- MB值显著高于 组和 组 (分别 P=0 .0 2 2 0、0 .0 10 8、0 .0 2 0 2和 0 .0 2 95 ) ;主动脉开放 6 0 min时 , 组患者 CK- MB值也高于 组 (P<0 .0 0 0 1) ;在主动脉开放 10、30 min时 , 组 MDA值明显高于 组 (分别 P=0 .0 0 6 0、0 .0 36 4) ;在主动脉开放 10min时 , 组 SOD值也高于 、 组 (分别 P=0 .0 0 0 1和 0 .0 0 84 )。各组 CK- MB值与主动脉阻断时间呈正相关 (r=0 .5 5～ 0 .81,P均 <0 .0 5 ) ;CK- MB值与 SOD、MDA值之间无明显相关性 ;MDA与 SOD间 组和

Objective: To study the effects of inhalation enflurane (Enf) before aortic clamping on myocardial reperfusion injury in cardiac surgery with cardiopulmonary bypass (CPB).Methods:Thirty patents undergoing selective cardiac valve replacement were randomly allocated to three groups.Group Ⅰ and group Ⅱ inhaled 1.0 MAC and 0.5 MAC Enf before clamping aorta, respectively.Group Ⅲ was the control group interval administration with Fentanyl.Results:Immediately upon aortic clamp release (T2),the value of CK-MB,MDA and SOD of all the groups was significantly increased,however,their concentration did not peak significantly until T3 and T4(10 and 30 min after clamp aorta release).The levels at 60 min (T5) and 24 hours (T6) aorta were lower than T4 but still higher than T 0.At T3 and T4,CK-MB levels in group Ⅰ were significantly higher than those in Ⅱ and Ⅲ groups (P= 0.0220,0.0108 and 0.0202,0.0295).At T6,the CK-MB level of group Ⅱ was significantly higher than that of group Ⅲ (P<0.0001).At T4 and T5,the MDA value of group Ⅰ was higher than that of group Ⅱ(P=0.0060 and 0.0364).Meanwhile,the SOD level in group Ⅰ was also higher than that of group Ⅱ and group Ⅲ at the T4 point(P<0.0001 and 0.0084).There was a correlation between the CK-MB value and the aorta clamping time,correlation coeficient range being 0.55~0.81,(P<0.05).However,there was no correlation between the CK-MB and MDA,SOD.Conclusion:There is ischemia reperfusion injury during cardiac surgery CPB with the increase of OFR production and elevation of the antioxidant reserve.Inhalation of large dose of enflurane may result in increased myocardial ischemia reperfusion injury manifested by elevated levels of myocardial enzymes and OFR production.