七氟醚及丙泊酚对心肌缺血-再灌注损伤的影响  

A clinical study of cardiopretective effects of preconditionning with sevoflurane or propofol in patients undergoing coronary artery bypass graft surgery by off-pump

作　　者：戚杨颂[1] 蒋伟[1] 刘勇[1] 梁姣[1] 郑宏[2] 

机构地区：[1]新疆医科大学第四附属医院手术麻醉科戚杨颂、蒋伟、刘勇、梁姣,830000 [2]新疆医科大学第一附属医院麻醉科郑宏,830000

出　　处：《临床麻醉学杂志》2011年第5期477-479,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察七氟醚及丙泊酚对非体外循环下行冠状动脉搭桥术患者心肌功能的影响。方法 60例择期行非体外循环下冠状动脉搭桥术的患者随机均分为七氟醚组(S组)和丙泊酚组(P组)。S组从手术开始至缝皮结束时吸入2.3最低肺泡有效浓度七氟醚,P组则靶控泵入3μg/ml的丙泊酚。检测术前、手术结束时、术后2、4 h血浆心肌肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)水平,并记录入室前、切皮时、劈胸骨时、手术结束时HR、MAP、CVP及恶性心律失常的发生率。结果再灌注后两组血浆CK-MB和cTnI水平均升高,且术后2、4 h P组高于S组(P<0.05)。两组间HR、MAP、CVP的差异无统计学意义。结论七氟醚或丙泊酚缺血预处理对非体外循环下行冠状动脉搭桥术患者心肌均有保护作用,其中七氟醚效果更好。Objective To observe the cardiopretective effects of preconditionning with sevoflurane or propofol in patients undergoing coronary artery bypass graft surgery by off-pump. Methods Sixty patients scheduled for elective coronary artery bypass graft（CABG） surgery were equally randomized into propofol group （P） and sevoflurane group （S）. The vaporizer was adjusted to 2.3 MAC of sevoflurane in group S and propofol target concentration infusion was controlled at 3 μg/ml in group P from the beginning of operation to the end of operation. Plasma concentrations of creatinekinase （CK MB）, cTnI were measured before anesthesia, after operation, and 2 h and 4 h after operation. HR, MAP, and CVP were recorded before anesthesia, at skin incision, sternotomy and the end of operation. Results The concentrations of CK-MB and cTnI increased significantly after reperfusion in the two groups, and group P had higher concentrations than group S （P〈0.05）. Conclusion Preconditioning with propofol or sevoflurane has a protective effect on myocardium in patients undergoing off-pump CABG,and sevoflurane had better efficacy.

关 键 词：七氟醚 丙泊酚 冠状动脉搭桥术 心肌 

分 类 号：R614[医药卫生—麻醉学]