丙泊酚与贝那普利对冠脉搭桥术肌酸激酶同工酶、肌钙蛋白浓度变化分析

Effect of Combination of Propofol with Benazepril on Creatine Kinase Isoenzyme and Troponin Levels after Coronary Artery Bypass Grafting

目的 :探讨丙泊酚与贝那普利联合用药对冠脉搭桥术后的肌酸激酶同工酶(CKI)、肌钙蛋白浓度的影响及其作用分析。方法:选取2014年1月-2016年1月在我院心内科门诊诊治的冠脉搭桥术患者150例,采用随机数字表法分为丙泊酚(PP)组、贝那普利(BNZ)组、两药联用(PP-BNZ)组,各50例。PP组在术中靶控输注PP,BNZ组在术前服用BNZ,PP-BNZ组在术前服用BNZ且在术中靶控输注PP,观察并记录术前、术后4 h,8 h,12 h,1 d,2 d,3 d患者血清肌酸激酶同工酶(CKI)、肌钙蛋白I(Tn I)浓度水平变化和术后并发症发生情况。结果:术前,三组患者的血清CKI和Tn I比较,差异无统计学意义(P>0.05);术后4~12 h时三组患者的血清CKI、Tn I值随时间的延长而增高,术后1天CKI与Tn I达到最高水平;术后1~3天,三组患者的血清CKI和Tn I值随时间的延长而降低,治疗后PP-BNZ组的CKI与Tn I值在任何时间点均高于PP组和BNZ组,差异有统计学意义(P<0.05)。术后1~3天,三组患者的心肌梗死率、房颤率、心率相比,均无显著差异(P>0.05);PP-BNZ组的心肌缺血率低于PP组和BNZ组,差异有统计学意义(P<0.05);三组患者并发症率差异无统计学意义(P>0.05),但PP-BNZ组患者并发症率低于PP组和BNZ组。结论 :PP与BNZ联合用药较单个用药在提高冠脉搭桥术患者血清中CKI,肌钙蛋白浓度方面具有更好的运用前景。

Objective:To investigate the effect of combination of propofol with benazepril on creatine kinase isoenzyme(CKI) and troponin(Tn I) levels after coronary artery bypass grafting. Methods:A total of 150 patients with indications coronary artery bypass grafting(CABG) who visited the department of cardiology, Henan Chest Hospital from January 2014 to January 2016 were randomly divided into three propofol(PP), benazepril(BNZ) and PP-BNZ groups, 50 for each. The patients in PP group were treated by target controlled infusion of propofol during operation, while those in BNZ group were treated with BNZ by oral route before operation. However, the patients in PP-BNZ group were treated with BNZ by oral route before operation and received target controlled infusion of propofol during operation. The CKI and Tn I levels in sera of patients before and 4 h, 8 h, 12 h, 1 d, 2 d and 3 d after operation were recorded, and the postoperative complications were observed. Results:The serum CKI and Tn I levels in three groups showed no significant difference before operation(P>0.05), which increased with time went on 4~12 h and reached the peak values 1 d, while decreased with time went on 1~3 d after operation. Both the serum CKI and Tn I levels at various time point after operation were significantly higher in PP-BNZ group than in PP and BNZ groups(P<0.05). The myocardial infarction rate, atrial fibrillation rate and heart rate 1~3 d after operation showed no significant difference in three groups(P>0.05). However, the myocardial ischemia rate in PP-BNZ group was lower than those in PP and BNZ groups(P<0.05). The incidence rates of complication showed no significant difference in three groups(P>0.05), while wsa lower in PP-BNZ group than in PP and BNZ groups. Conclusion:The combination of PP and BNZ was more hopeful to increase the serum CKI and Tn I levels of patients after coronary artery bypass grafting than application of either of the drugs.