不停跳冠脉搭桥术中急性等容血液稀释对心肌酶与肌钙蛋白Ⅰ的影响  

The influence of acute normovolemic hemodilution on myocardial enzyme and cardiac troponin I during off-pump coronary artery bypass surgery

作　　者：张亮[1] 卿恩明[1] 卢家凯[1] 董秀华[1] 胡适[1] 

机构地区：[1]首都医科大学附属北京安贞医院麻醉科,100029

出　　处：《临床麻醉学杂志》2012年第3期216-218,共3页Journal of Clinical Anesthesiology

摘　　要：目的评价不停跳冠脉搭桥术(OPCAB)中急性等容血液稀释(ANH)对心肌酶、肌钙蛋白I(cTnI)的影响。方法选择OPCAB患者60例,随机均分为ANH组(A组)和对照组(C组)。A组于麻醉平稳后经中心静脉采血,将红细胞压积(Hct)稀释到30%,同时输入等容量胶体液6%羟乙基淀粉;C组不行血液稀释。记录麻醉诱导后5 min(ANH前,T_1)、ANH后5 min(T_2)、30 min(T_3)、60 min(T_4)、120 min(T_5)、自体血输注完毕后10 min(T_6)及60 min(T_7)的心脏指数(CI)、肺循环阻力(PVR)、体循环阻力(SVR)、肺毛细血管楔压(PCWP)。于术前及术后4、24、48、72 h采集血液检测肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)及肌钙蛋白I(cTnI)的变化。结果与C组比较,T_3、T_4、T_6、T_7时A组CI明显升高(P<0.05);T_4～T_7时A组PCWP、PVR、SVR、Hb明显降低(P<0.05或P<0.01)。术后24、48、72 h两组CK、CK-MB、cTnI均明显高于术前,A组CK、CK-MB、cTnI明显低于C组(P<0.05或P<0.01)。结论适度ANH在OPCAB患者中应用安全性高,且对心肌具有一定保护作用。Objective To evaluate the influence of acute normovolemic hemodilution on myocardial enzyme and cardiac troponin I （cTnI） during off-pump coronary artery bypass surgery （OPCAB）. Methods Sixty patients scheduled for OPCAB were randomly assigned to an ANH group （group A） or a control group （group C） with 30 cases each. In group A, venous blood was withdrawn after anesthesia induction and then 6% hydroxyethyl starch was infused to maintain normovolemia, and group C were not given ANH. The hemodynamics and the content o{ hemoglobin in the arterial blood were recorded at 5 min after induction（T1 ） 5 min（T2 ）, 30 min（T3 ）, 60 min（T4 ）, 120 min（T5 ） after completion of ANH and 10 rain（T6 ） and 60 min（T7 ） after completion of infusion, cTnI and myocardial enzyme were measured at immediate and postoperative 4, 24, 48, and 72 h. Results Compared to group C, CI were significantly higher at T3 ,T4 T6, and PCWP, PVR, SVR, Hb were significantly lower at T4-T7 in group A （P~ 0. 05）. Postoperative 24, 48, 72 h, cTnI, CK, CK-MB of two groups were significantly higher than the preoperative In group A, the postoperative release of cTnI and myocardial enzyme were significantly lower than in group C （P〈0. 05 or P〈0. 01）. Conclusion ANH is not merely safe for OPCAB, but further attenuates myocardial injuries.

关 键 词：血液稀释 不停跳冠脉搭桥术 血流动力学 氧代谢 肌钙蛋白I 

分 类 号：R614[医药卫生—麻醉学]