瑞芬太尼经主动脉灌注管泵入对心肺转流心内直视手术患者心肌损伤的影响  

Effect of remifentani administed through aortic cannulation on myocardium injury in patients undergoing open heart surgery under CPB

作　　者：翟明玉[1] 顾尔伟[2] 李娟[1] 张雷[2] 

机构地区：[1]安徽省立医院南区麻醉科,合肥市230036 [2]安徽医科大学附属第一医院麻醉科

出　　处：《临床麻醉学杂志》2011年第9期844-847,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨瑞芬太尼经主动脉灌注管泵入对心肺转流（CPB）心内直视手术患者心肌损伤的影响。方法单纯房、室间隔缺损患者60例，年龄18-45岁，ASAⅡ或Ⅲ级，心功能I或Ⅱ级，随机均分为四组，于手术完成后主动脉开放前8min，R1、R1、R3组分别以2、4、8g·kμg^-1·min^-1泵入瑞芬太尼，C组泵人等容量生理盐水。检测麻醉诱导前、主动脉开放后4、8、24、48h心肌肌钙蛋白I（cTnI）、丙二醛（MDA）浓度及磷酸肌酸激酶同工酶（CK—MB）、超氧化物歧化酶（SOD）活性。结果主动脉开放后4h及8h，与C组比较，R1、R2、R3组cTnI、MDA浓度及CK-MB活性明显降低，SOD活性明显升高（P〈0．05）；与R1组比较，R2、R3组cTnI、MDA浓度及CK—MB活性明显降低，SOD活性升高（P〈0．05）。主动脉开放后24h，R3组cTnI、MDA浓度及CKMB活性明显低于其它三组（P〈0．05）。结论瑞芬太尼经主动脉灌注管泵入对CPB心内直视手术患者心肌损伤有一定保护作用，其作用机制可能与抑制脂质过氧化反应有关。Objective To investigate the effects of adding remifentanil through aortic on myoeardium injury in patients undergoing open heart surgery under CPB. Methods sixty patients with congenital ventricular septal defect or artial septal （ASA grade Ⅱor Ⅲ, NYHA class Ⅰ or Ⅱ ）, aged 18 to 45 yrs, were randomly divided into 4 groups （n=15 each）： remifentanil groups （R1, R2,Ra） and control group （C）. Patients received an aortic infusion of remifentanil （diluted to 10,20,40μg/ml with normal saline） 2, 4, 8μg.kg^-1 .min ^-1 lasting for 8 min before aortic unclamping and lasted for 5 min in group R1, Re, ira. In group C, the same volume of normal saline was infused. Before induction of anesthesia （baseline） and 4, 8, 24, 48 h after aortic unclamping venous blood samples 4 ml were obtained from the right internal jugular vein for determination of red blood cell specific volume （Het）, plasma concentrations of cTnI and MDA and activities of CK-MB and SOD. Record the time of aortic clamping and the postoperative duration of vasoactive drugs. Results Compared with group C, the plasma concentrations of eTnI, MDA and the activity of CK-MB were significantly lower at 4 h and 8 h after aortic unclamping in groups R1 , R2 and Ra, while the activity of SOD was significantly higher （P〈0. 05）. The plasma concentrations of cTnI and MDA and the activity of CK- MB were significantly lower at 4 h and 8 h after aortic unclamping in groups R2 and Ra than those in group R1, while the activity of SOD was significantly higher （P〈0. 05）. The plasma concentrations of eTnI and MDA and the activity of CKMB in groups R3 were significantly lower than in groups R1, R2 and C at 24 h after aortic unclamping （P〈0. 05）. The postoperative duration of vasoactive drugs was significantly shorter in groups R1 , R2 and R3（35 ±7 ; 34 ± 6 ; 34 ± 7） as compared with group C （67 ±9） （P % 0.01）. Conclusion Remifentanil added through aortic can attenuate myoeardium ischemia reperfusion injury in pa

关 键 词：瑞芬太尼 先天性心脏病 心肌再灌注损伤 心肺转流 

分 类 号：R614[医药卫生—麻醉学]