异氟醚预处理对婴幼儿体外循环后心肌的保护作用  

Myocardial protective effects of pretreatment with isoflurane during open heart surgery in infants under cardiopulmonary bypass

作　　者：顾春虎[1] 王云雅[2] 陈敏[3] 魏旭峰[1] 刘金成[1] 董小超[1] 刘洋[1] 易定华[1] 

机构地区：[1]第四军医大学西京医院心脏外科,陕西西安710032 [2]第四军医大学西京医院核医学科,陕西西安710032 [3]第四军医大学西京医院麻醉科,陕西西安710032

出　　处：《心脏杂志》2008年第4期478-481,共4页Chinese Heart Journal

基　　金：国家科技支撑计划项目资助(200BAI01A08)

摘　　要：目的观察异氟醚预处理对体外循环下婴幼儿心内直视手术心肌的保护作用。方法将100例先天性心脏病患儿,随机分为预处理组和对照组,观察两组转机时间、主动脉阻断时间、心脏复跳情况、循环情况。分别于麻醉后、体外循环主动脉开放后15min、4h、24h时间点取血样,检测血清降钙素基因相关肽(CGRP)、内皮素(ET)、心房钠尿肽(ANP)、心肌钙蛋白(cTnI)的变化。结果两组转机时间、主动脉阻断时间、开放至复跳时间无显著差异,预处理组的自动复跳率、复跳后低血压发生率及术后24h低血压发生率均优于对照组(P<0.05)。主动脉开放15min后,CGRP和ANP在两组患者均显著增高(P<0.01),但预处理组明显高于对照组(P<0.05);ET和cTnI在主动脉开放后也显著上升(P<0.01),但预处理组上升幅度明显低于对照组(P<0.05)。结论异氟醚预处理能减少心肌的缺血/再灌注损伤,促进体外循环后心功能恢复。AIM To investigate the myocardial protective effects of pretreatment with isoflurane during open heart surgery in infants under cardiopulmonary bypass （CPB）. METHODS One hundred infants with congenital heart disease undergoing cardiac operation were randomized into isoflurane preconditioning group （n = 50） and control group （n = 50）. Blood samples were taken for the measurement of CGRP, ET, ANP and cTnI after anesthesia （before CPB） , at 15 min after aortic declamping and 4 and 24 hours after the termination of CPB. The aortic clamping time and CPB time were recorded. The state of circulation and the heart spontaneous return were observed. RESULTS There were no significant differences in duration of bypass, aortic cross clamping time and the time from aortic opening to resumption of heart beating between preconditioning group and control group. Incidence of spontaneous resuscitation was higher in preconditioning group than that in control group （P 〈 0. 05 ）. Incidence of hypotenion after resumption of heart beating and in the following 24 h was lower in group Ⅰ than that in control group （P 〈 0. 05 ）. The CGRP and ANP levels of preconditioning group and control group significantly increased at 15 min after aortic opening as compared with those before CPB （ P 〈 0. 01 ）. But the CGRP and ANP levels of preconditioning group were higher than those of control group. Compared with the concentrations of ET-1 and cTnI before CPB, the levels increased significantly after aortic opening （P 〈 0. 01 ）. However,the ET-1 and cTnI levels of preconditioning group were lower than those of control group （ P 〈 0. 05 ）. CONCLUSION Isoflurane preconditioning protects against myocardium injury during open heart surgery in infants under cardiopulmonary bypass. Key words： isoflurane ; preconditioning; cardiopulmonary bypass ; calcitonin gene related peptide; atrial natriuretic peptide; endothelin; cardiac troponin I

关 键 词：异氟醚 预处理 体外循环 降钙素基因相关肽 内皮素 心房钠尿肽 心肌钙蛋白 

分 类 号：R654.1[医药卫生—外科学]