丙泊酚、咪达唑仑对小儿紫绀型先天性心脏病体外循环心内直视术的心肌保护作用  

Cardioprotective effects of propofol and midazolam in children with congenital heart diseases undergoing open heart surgery

作　　者：邹捍东[1] 周青山[1] 夏文芳[1] 吴灵渝[1] 程邦昌[1] 

机构地区：[1]武汉大学人民医院麻醉科,430060

出　　处：《中华医学杂志》2007年第33期2309-2312,共4页National Medical Journal of China

基　　金：湖北省卫生厅科研基金(JX2828);湖北省科技攻关计划基金(2005AA304812)

摘　　要：目的比较观察丙泊酚和咪达唑仑对紫绀型先天性心脏病患儿心内直视术的心肌保护作用。方法选择 ASA Ⅰ～Ⅱ级心内直视手术的紫绀型先天性心脏病患儿32例,随机等分为两组,每组16例,丙泊酚复合小剂量芬太尼组(PF 组),咪达唑仑复合小剂量芬太尼组(MF 组)。观察患儿血流动力学变化,脉搏血氧饱和度及体温,记录术后拔管时间及术后 ICU 停留时间;取主动脉阻断后10～20 min(T_2)和主动脉开放后10～20 min(T_3)时的心肌组织,观察心肌血红素加氧酶-1(HO-1)的表达;采集开放静脉通路时(T_0)、主动脉开放后2 h(T_4)、术后24 h(T_5)的静脉血,检测血浆中肌钙蛋白Ⅰ(cTnI)含量。结果 PF 组患儿术后的平均拔管时间和平均 ICU 停留时间较 MF 组短(分别为14.17 h vs 23.65 h,30.17 h vs 49.47 h);两组患儿 T_4时(PF:97 ng/ml±33 ng/ml,MF:138 ng/ml±56 ng/ml)cTnI 的水平均高于 T_0(PF.0.17 ng/ml±0.10 ng/ml,MF:0.62 ng/ml±0.96 ng/ml)和 T_5(PF:23 ng/ml±13 ng/ml,MF:24 ng/ml±6 ng/ml),T_5时 cTnI 的水平高于 T_0,但两组间同时点值比较差异无统计学意义;PF 和 MF 组 T_2时心肌 HO-1表达均低于 T_3(灰度值 PF:182.2±0.8vs 125.6±2.1,MF:193.5±1.4 vs 145.5±7.4),MF 组患儿 T_2、T_3时心肌 HO-1的表达低于 PF 组同时点值。结论丙泊酚和咪达唑仑对紫绀型先天性心脏病患儿体外循环心内直视术心肌有保护作用,丙泊酚在刺激心肌保护性蛋白 HO-1方面优于咪达唑仑。Objective To observe the cardioprotective effects of propofol and midazolam in children with congenital heart diseases undergoing open heart surgery. Methods Thirty-two children with cyanotic congenital heart diseases of ASA classes I- Ⅱ were randomly divided into 2 equal groups： propofol combined with low dose fentanyl group （ Group PF） and midazolam combined with low dose fentanyl group （Group MF）. The changes of hemedynaics, ECG, SpO2, nasopharyngeal and rectal temperatures were monitored continuously. The time of tracheal extubation and ICU staying time were recorded. Venous blood samples were collected when the venous channel was opened （ To ）, 2 h after declamping of the aorta （ T4 ）, and 24 h after operation （ T5 ） to detect the plasma cardiac troponin I （cTnI）. Myocardium samples were collected 10-20 rain after aorta cross-clamp （ T2 ）, and 10-20 min after declamping of the aorta （ T3 ） to undergo immunohistochemistry to observe the expression of heme oxygense-1 （HO-1）. Results The tracheal time of Group GF was 14.17 h, significantly shorter than that of Group MF （23.65 h, P 〈 0.05）, and the ICU staying time of Group GF was 30.17 h, significantly shorter than that of Group MF （49.47 h, P〈0.05）. The plasma cTnI level at T4 of Group GF was 97 ng/ml ±33 ng/ml, significantly higher than those at To （0.17 ng/ml ± 0.10 ng/ml, P 〈 0.01 ） and T5 （ 23 ng/ml ± 13 ng/ml, P 〈 0.01 ）. The plasma eTnI level at T4 of Group MF was138 ng/ml ±56 ng/ml, significantly higher than those at TO （0.62 ng/ml ± 0.96 ng/ml, P 〈0.01 ） and T5 （24 ng/ml ±6 ng/ml, P 〈0.01 ）. And the plasma eTnI levels at T5 of these 2 groups were both significantly higher than those at TO （both P 〈 0.01 ）, however, there was no significant difference in the plasma eTnI level at any time point between these 2 groups. The grey values of HO-1 incardiac muscle cells at T2 of Groups GF and MF were 182.2 ± 0.8 and 193.5± 1.4, both significantly higher than those at T3 �

关 键 词：麻醉药 心脏缺损 先天性 肌钙蛋白I 

分 类 号：R726.5[医药卫生—儿科]