异丙酚及尼卡地平对小儿体外循环期间血管内皮因子的影响

Effects of Propofol and Nicardipine on Vascular Endothelial Factors Undergoing Cardiac Surgery with CPB in Children

目的 观察小儿先心病手术体外循环期间应用异丙酚或尼卡地平对血管内皮因子的影响,探索合理的麻醉管理方法。方法 36例室间隔缺损伴肺动脉高压患儿随机分为异丙酚组、尼卡地平组和对照组。分别于麻醉诱导后(T1)、转流前(T2)、转流30min(T3)、停转流后2h(T4)和术后24h(T5)抽取血样,测定内皮素(ET)、一氧化氮(NO)、血栓烷B_2(TXB_2)和6-酮前列腺素F_(1a)(6-K-F)水平,同时观察各项血流动力学参数的变化。结果 T1、T2、T5时各组血流动力学参数及血管内皮因子无显著变化;T3时对照组平均动脉压(MAP)明显升高(P<0.05),ET增加,NO/ET比值降低(P<0.01),用药二组ET明显减少(P<0.05);T4时各组心率均明显增快(P<0.01);T3、T4时尼卡地平组6-K-F升高尤为明显(P<0.01)。结论 异丙酚可不同程度地抑制体外循环期间机体的血管舒缩反应。在体外循环的麻醉管理中,异丙酚可作为调控麻醉深度、抑制炎性应激反应等综合措施之一,其作用较尼卡地平更为明显。

Objective To invesigate the effects of propofol and nicardipine on vascular endothe-lial factors and the adequate anesthetic management during cardiopulmonary bypass ( CPB) in children. Methods Thirty - six patients with ventricular septal defects and pulmonary hypertension were randomly divided into three groups: propofol( A) ,nicardipine (B)and control(C). Blood samples were taken simultaneously from arterial line after induction ( T1 ) , before CPB ( T2 ) , bypass 30min ( T3 ) , after 2h CPB (T4) and after 24h operation ( T5 ) for determination of plasma concentration of endothelin (ET) , Nitric oxide (NO) , Thromboxane A2 (TXB2 ) and Epoprostenol (6 -K -F). Results Parameters of hemody-namics at T1, T2 and T5 were normal of each groups during CPB, MAP was raised in group C(P <0. 05) at T3. HR was faster (P < 0. 01) at T4. ET of A and B groups were decreased and group A more than B at T3. But ET of group C was increased (P < 0. 05) ,NO/ET ratio was decreased. 6 - K - P was mildly increased and TXB2 was normal at T3 and T4 of each groups. All data were return to pre - operative level after 24h operation. Conclusion Propofol can depress the vasomotor reaction at different degree during CPB in children. During the anesthetic management of CPB , propofol can be used as one of the methods to modulate the depth anesthesia and depress the inflammatory reaction. The effects of rropofol are more obvious than those of ncadipine.