舒芬太尼后处理对体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响  

Effect of sufentanil postconditioning on myocardial ischemia-reperfusion injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass

作　　者：朱德浩[1] 顾尔伟[2] 赵佑君[1] 陈庆书[3] 陈立建[2] 张雷[2] 李伟鹏[4] 

机构地区：[1]蚌埠医学院第一附属医院麻醉科,233004 [2]安徽医科大学第一附属医院麻醉科 [3]蚌埠医学院第一附属医院检验科,233004 [4]蚌埠医学院第一附属医院核医学科,233004

出　　处：《中华麻醉学杂志》2012年第7期824-827,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价舒芬太尼后处理对体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响。方法择期拟行心脏瓣膜置换术患者60例，性别不限，年龄19～64岁，ASA分级Ⅱ或Ⅲ级，心功能分级Ⅱ或Ⅲ级。采用随机数字表法，将患者随机分为4组（n=15）：对照组（C组）、舒芬太尼0．5μg／kg组（S1组）、舒芬太尼1．0gg／kg组（S2组）和舒芬太尼2．0μg／kg组（S3组）。S1-3组于主动脉开放前5min时经主动脉根部分别输注舒芬太尼0．5、1．0和2．0μg／kg，稀释容量为2ml／kg，输注时间2min，C组给予等容量生理盐水。于麻醉诱导前即刻（T2）、主动脉开放2h（T1）、4h（T2）、8h（T3）、24h（T4）和48h（B）时抽取桡动脉血样，测定血浆心肌肌钙蛋白I（cTnI）、丙二醛（MDA）浓度和肌酸磷酸激酶同工酶（CK—MB）、超氧化物歧化酶（SOD）活性。记录气管导管拔除时间、ICU停留时间、术后24h时心肌收缩力评分、术后24h引流量，记录心脏自动复跳及心血管不良事件发生的情况。结果与C组比较，S1组T1-3时血浆cTnI、MDA浓度和CK—MB活性降低，SOD活性升高，S2，3组T1-5时血浆cTnI浓度和CK—MB活性降低，T1-4时血浆MDA浓度降低，SOD活性升高，气管导管拔除时间和ICU停留时间缩短，术后24h时心肌收缩力评分和心血管不良事件发生率降低（P〈0．05）；与S1组比较，S2.3组T4，5时血浆cTnI浓度和CK—MB活性降低，T4时MDA浓度降低，T3.4时SOD活性升高，术后24h时心肌收缩力评分降低（P〈0．05）。结论舒芬太尼后处理可减轻体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤，其机制与抑制脂质过氧化反应有关。Objective To investigate the effect of sufentanil postconditioning on myocardial ischemiareperfusion （I/R） injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass （CPB）. Methods Sixty ASA II or III patients （NYHA II or III ） of both sexes, aged 19-64 yr, scheduled for cardiac valve replacement under CPB, were randomly divided into 4 groups （ n = 15 each）： control group （group C）, sufentanil 0.5 μg/kg group （group St ）, sufentanil 1.0 μg/kg group （group S2 ） and sufentanil 2.0 μg/kg group （group S3 ）. In groupsS1 0 S2 and S3, sufentanil 0.5, 1.0 and 2.0μg/kg were infused over 2 rain via aortic root 5 min before aortic unclamping respectively. In group C, the equal volume of normal saline （2 ml/kg） was infused instead of sufentanil. Blood samples were taken from the radial artery immediately before induction of anesthesia （T2） and at 2, 4, 8, 24 and 48 h after aortic unclamping （T1-5） for determination of plasma concentrations of cardiac troponin- I （cTnI） and malondialdehyde （MDA） and activities of creatine kinase isoenzyme- MB （ CK- MB） and superoxide dismutase （SOD）. The duration of CPB, time of aortic clamping, extubation time, duration of stay in ICU, and myocardial contractility score and volume of drainage at 24 h after the operation were recorded.The restoration of spontaneous heart beat and adverse cardiovascular events were observed. Results The plasma cTnI, and MDA concentrations and CK-MB activity were significantly lower, while the SOD activity was significantly higher at T1-3 in group S1 than in group C （P 〈 0.05）. The plasma cTnI concentration and CK-MB activity were significantly lower at T1-5 , the plasma MDA concentration was significantly lower at T1-4, and SOD activity was significantly higher at T1-4, the extubation time and duration of stay in ICU were significantly shorter, and the myocardial contractility score at 24 h after the operation and incidence of adverse cardiovascular events were si

关 键 词：舒芬太尼 心肺转流术 心肌再灌注损伤 后处理 

分 类 号：R614[医药卫生—麻醉学]