舒芬太尼预处理对心脏瓣膜置换术患者体外循环诱导心肌损伤的影响  

Protective effects of sufentanil preconditioning on myocardial injury induced by cardiopulmonary bypass in cardiac valve replacement patients

作　　者：韦鹏[1,2] 顾尔伟[1] 梁启胜[1] 陈建文[3] 张凡[3] 

机构地区：[1]安徽医科大学第一附属医院麻醉科,安徽合肥230022 [2]蚌埠医学院第一附属医院麻醉科,安徽蚌埠233004 [3]蚌埠医学院第一附属医院检验科,安徽蚌埠233004

出　　处：《蚌埠医学院学报》2011年第6期564-567,共4页Journal of Bengbu Medical College

基　　金：安徽省卫生厅自然科学研究资助项目(09AO19)

摘　　要：目的:探讨舒芬太尼预处理对心脏瓣膜置换术患者体外循环(CPB)诱导心肌缺血-再灌注损伤的影响。方法:将择期45例心脏瓣膜置换术患者随机分为3组,每组15例,其中对照组(A组)于主动脉阻断前以1 ml/min静脉输注生理盐水隔5 min,重复3次;低剂量舒芬太尼预处理组(B组)和高剂量舒芬太尼预处理组(C组)分别在主动脉阻断前以0.2、0.4μg.kg-1.min-1静脉输注舒芬太尼5 min,间隔5 min后重复输注舒芬太尼,重复3次。于麻醉诱导前(T1)及主动脉开放后4 h(T2)、8 h(T3)、24 h(T4)、48 h(T5)采静脉血,测定血浆肌酸磷酸激酶同工酶(CK-MB)活性及心肌肌钙蛋白I(cTnI)浓度。记录血流动力学和术后呼吸机辅助时间、术后24 h收缩力评分、术后24 h引流量、重症监护病房(ICU)驻留时间等指标。结果:A组血浆cTnI水平T2时点开始升高,T3时点达到峰值,以后开始回降,至T5降至接近正常,但仍高于T1时点值(P<0.01)。B组和C组cTnI水平于T2时点显著升高达到峰值,T3时点开始回降,T4时点已回降至接近正常水平,T5时基本正常。与A组比较,B组和C组T2～T5时血浆cTnI水平明显降低(P<0.05～P<0.01),B组和C组T4和T5时血浆CK-MB活性明显降低(P<0.05～P<0.01)。与A组比较,B组和C组术后呼吸机辅助呼吸时间、术后24 h收缩力评分、术后24 h引流量、ICU留驻时间均明显减少(P<0.05)。结论:舒芬太尼预处理可减轻心脏瓣膜置换术患者CPB诱导的心肌损伤。Objective：To study the protective effects of sufentanil preconditioning on myocardial ischemia-reperfusion injury induced by cardiopulmonary bypass（CPB） in cardiac valve replacement patients. Methods： Forty-five patients scheduled for elective cardiac valve replacement with CPB were randomly divided into three groups（n=15）, control group（ group A）, patients received 3 episodes of 5 minutes normal saline infusion at 1 ml/min at 5 minutes interval before aorta clamping; low-dose sufentanil preconditioning group （group B） and high-dose sufentanil preconditioning group（group C） patients that received 3 episodes of 5 minutes sufentanil infusion at O. 2,0.4μg kg^-1 . min^-1 at 5 min interval before aorta clamping, respectively. Plasma levels of cardiac troponin I （cTnI） and creatine phosphokinase isoenzyme （ CK-MB ） before induction of anesthesia （ T1 ） ,4 （T2 ）, 8 （ T3 ）, 24 （ T4 ） and 48 hours （ T5 ） after aorta unclamping were measured. The hemodynamics and postoperative assistant ventilation,24 hours postoperation contraction score, drainage volumn and stay in the intensive care unit were also recorded. Results：In group A, plasma cTnI levels at T2, T3 ,T4 and T5 were higher than that at T1 （P 〈 0.01 ）, reached the peak level at T3, then declined at T4, In group B and C plasma cTnI levels at T2, T3, and T4 were higher than that at T1 （P 〈0.05 - P 〈0.01 ） ,and reached the peak level at T2 ,then declined to normal range at T5. Plasma cTnl at T2 ,T3 ,T4 and T5 in group B and C were lower than that in group A（P 〈0.05 - P 〈0.01 ） ,respectively. Plasma CK-MB levels at T2 , T3, T4 and T5 were higher than that at T1 in three groups（ P 〈 0.05 - P 〈 0.01 ）. There were no significant differences in plasma CK-MB levels among three groups at T2 , T3, but the values were lower in group B and C than that in group A at T4, T5 （ P 〈 0. 05 - P 〈 0. 01 ）.Intubation time, the requirement for inotropics, the volume of wound drainage in first pos

关 键 词：心脏瓣膜疾病/外科手术 心脏瓣膜置换术 心肌保护 舒芬太尼 心肌肌钙蛋白I 

分 类 号：R654.1[医药卫生—外科学]