非体外循环冠状动脉旁路移植术中舒芬太尼的心肌保护作用研究

Study on myocardial protective effect of sufentanil in the operation of off-pump coronary artery bypass grafting

目的探讨非体外循环冠状动脉旁路移植术中舒芬太尼的心肌保护作用。方法选择2012年7月~2014年5月河北医科大学第四医院接诊的100例非体外循环冠状动脉旁路移植术患者进行研究。随机分为观察组和对照组。观察组50例患者,采用舒芬太尼麻醉诱导。对照组50例患者,采用芬太尼麻醉诱导。比较2组患者各个时间(麻醉前、桥血管结束吻合时、手术结束时、术后8、16、24 h)的白介素-6(interleukin-6,IL-6)、白细胞介素-10(interleukin-10,IL-10)、肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)、心肌肌钙蛋白(cardiac troponin I,c Tn I)水平。结果观察组与对照组的IL-6水平在麻醉前相比较无统计学意义;观察组的IL-6水平在麻醉后明显低于对照组,2者相比差异有统计学意义(P<0.05)。观察组与对照组的IL-10水平在麻醉前相比较无统计学意义;观察组的IL-10水平在麻醉后明显高于对照组,2者相比差异有统计学意义(P<0.05)。观察组与对照组的CK-MB水平在手术结束后均先升高后降低;观察组与对照组的CK-MB水平相比无统计学意义。观察组的与对照组的c Tn I水平在手术结束时相比较无统计学意义;观察组的c Tn I水平在术后8 h明显低于对照组,2者比较差异有统计学意义(P<0.05)。结论非体外循环冠状动脉旁路移植术中舒芬太尼的心肌保护作用良好。

Objective To evaluate and analyse the cardioprotective effect of sufentanil in off-pump coronary artery bypass grafting. Methods 100 patients with off-pump coronary artery bypass grafting from July 2012 to May 2014 in the fourth hospital of hebei medical university were researched. They were divided randomly into observation and control groups. Observation group had 50 patients,and they were treated by anesthesia induction of sufentanil. Control group had 50 patients,which were treated by anesthesia induction of fentanyl. Two groups' IL-6 levels,IL-10 levels,CK-MB levels,c Tn I levels were compared at different times(before anesthesia,end anastomosis of grafts,the end of surgery,8 h after surgery,16 h after surgery,24 h after surgery). Results There was no significant difference between IL-6 level of the observation group and IL-6 level of the control group before anesthesia; IL-6 level in the observation group was significantly lower after anesthesia than control group,and there was significant difference(P <0. 05). There was no significant difference between IL-10 level of the observation group and IL-10 level of the control group before anesthesia; IL-10 level of observation group was significantly higher after anesthesia than control group,and there were significant difference(P < 0. 05). CK-MB levels in the observation group and the control group raised after the end of surgery and then reduced; there was no significant difference between CK-MB level of the observation group and CK-MB level of the control group before anesthesia. The difference between c Tn I levels in observation group and control group at the end of surgery wasn't statistically significant; c Tn I levels after 8 h in observation group was significantly lower than control group,and there was statistically significant difference(P < 0. 05). Conclusion The cardioprotective effect of sufentanil in off-pump coronary artery bypass grafting is good.