异氟醚预处理对心肌缺血再灌注损伤的保护作用

Protective effect of isoflurane preconditioning on myocardial ischemia reperfusion injury

目的:观察异氟醚预处理对体外循环心内直视手术心肌的保护作用。方法:20例瓣膜置换术患者(ASA 2～3 级),随机分为预处理组(Ⅰ组)和对照组(C组)。分别于麻醉后(T_1),主动脉开放后15分钟(T_2)、2小时(T_3)、24小时(T_4)时间点取血样,检测血清CGRP、ET、cTnI;另于术前、术后第1、3天记录同步12导联心电图.测定其QTd和 QTcd。结果:主动脉开放后,CGRP含量在两组患者24小时之内都有显著增加(P<0.01),T_2时,预处理组的CGRP水平明显高于对照组的(P<0.05);ET在T_2时两组都有显著上升(P<0.01),但预处理组的上升幅度明显低于对照组(P<0.05);T3、T4时,对照组cTnI水平显著高于预处理组;术后两组QTd和 QTcd显著增加(P<0.01),其中对照组的增加较多,且第1天明显多于预处理组(P<0.05);结论:异氟醚预处理能减少心肌的缺血再灌注损伤,降低术后心律失常发生率,有利体外循环后心功能恢复。

Objective: To observe protective effect of isoflurane preconditioning on myocardial ischemia reperfusion injury. Methods: Twenty patients undergoing valve replacement (ASA 2-3 class) were randomly divided into two groups: Isoflurane preconditioning group (group I) and control group (group C). Serum CGRP, ET, ANP, cTnI contents were detected at post-anesthesia induction (T1) and fifteenth minute (T2). second hour (T3), twenty-fourth hour (T4) after reperfusion. Electrocardiograms were recorded before operation and first, third day after operation. QTd and corrected value of QT dispersion (QTcd) were measured. Results; CGRP of two groups were significantly increased in twenty-fourth hours after reperfusion (P<0. 01), the CGRP value of group I was significantly higher than that of group C at T2 (P<0. 05). ET levels of two groups were markedly elevated at T2 (P<0. 01), but the level of elevation of group I was markedly lower than that of group C (P<0. 05). cTnl level of group C was higher than that of group I at T3, T4. The QTd, QTcd of two groups significantly increased after operation (P<0. 01); those of group C increased more and at first day was markedly higher than of group I (P<0. 05). Conclusion: Isoflurane preconditioning can reduce myocardial ischemical reperfusion injury.