不同剂量乌司他丁对非体外循环冠状动脉旁路移植术患者心肌保护作用  

Myocardial Protective Effects of Ulinastatin on patients with Off-pump Coronary Artery Bypass Grafting

作　　者：雷波[1] 曹兴华[1] 刘勇[1] 蒋伟[1] 侯守琳[1] 戚杨颂[1] 

机构地区：[1]新疆医科大学附属中医医院手术麻醉科,新疆乌鲁木齐830000

出　　处：《新疆医学》2013年第1期42-45,共4页Xinjiang Medical Journal

摘　　要：目的:比较不同剂量乌司他丁对非体外循环冠状动脉旁路移植术患者的心肌保护作用,为临床合理应用提供理论依据。方法:择期行非体外循环冠状动脉旁路移植术患者60例,性别不限,年龄40～59岁,体重50～94kg,ASA分级Ⅱ或Ⅲ级,心功能分级Ⅱ或Ⅲ级,随机分为3组(n=20):对照组组(C组),低剂量乌司他丁组(L组)和高剂量乌司他丁组(H组)。麻醉诱导:静脉注射咪达唑仑0.08 mg/kg、舒芬太尼2цg/kg和维库溴铵0.1mg/kg,气管插管后行间歇正压机械通气,维持P_(ET)CO_230～35mmHg。麻醉维持:吸入七氟醚,初始浓度为1.7%,逐渐加大浓度至2～3%;三组静脉输注舒芬太尼0.04цg·kg^(-1)·min^(-1)和维库溴铵0.8gg.kg^(-1)·min^(-1),维持BIS值40～50。分别于入室时、切皮即刻、劈胸骨即刻和术毕时,记录HR、MAP和CVP。分别于切皮前即刻、术毕、术后2和12h时,采集中心静脉血样,测定血浆心肌肌酸激酶同工酶(CK-MB)的活性和心肌肌钙蛋白I(cTnl)的浓度。记录术中心血管不良事件的发生情况。结果三组各时点血液动力学指标无统计学差异。H组和L组术中心血管不良事件发生率较C组减少,且差异具有统计学意义(P<0.05),H组组术中心血管不良事件发生率较L组减少,但差异无统计学意义(P>0.05)。C组,L组和H组术毕、术后2和12h时血浆CK-MB活性和cTnI浓度均升高,且L组和H组与C组比较升高值较小,差异有统计学意义(P<0.05),H组较L组升高值小,但两组间比较差异无统计学意义(P>0.05)。结论乌司他丁应用于非体外循冠状动脉旁路移植术患者,可以降低围术期心血管不良事件的发生率,尤以高剂量乌司他丁对非体外循冠状动脉旁路移植术患者的心肌保护效果更佳。Objective To investigated the myocardial protection of coronary artery bypass grafting., for reasonable clinic practice. Methods ulinastatin in patients undergoing off-pump sixty patients scheduled for elective coronary artery bypass graft （CABG）surgery were randomly divided into three groups of 20 patients： that is control group（C）, low-dose ulinastatin group （L）and high-dose ulinastatin group g （H）.the vaporizer was adjusted into 1.73% re- spectively from the beginning of operation to the end of procedure according to concentration-effects strateges.The central venous blood samples were collected for the measurements of creatinekinase （CK-MB）,cTnI before anesthe- sia （TI）, immediately after operation （T2）and 2h （T3）,12h （T4）after operation. HR, MAP, PAP, CYP were recorded before anesthesia（tl）,skin incision （t2）, stemotomy（t3） and end of operation （td） respectively. Results At each period of time after skin incision, compared with TI, As for the contents of CK-MB and cTnI were increased significantly in all of the groups （p〈0.05）.But compared with in group C was increased significantly （p〈0.05）. compared group L and group H, the content of CK-MB and cTnI with group L, group H was increased non-significantly （p〉0.05）. As for the incidence of adverse eardiovascular events were decreased significantly in group L and in group H compared with group C （p〈0.05）.compared with group H,group L was decreased non-significantly （p〉0.05）. Conclusion Compared with control group, ulinastatin applied to the off-pump coronary artery bypass graft surgery pa- tients anesthesia, did decrease the perioperative adverse event incidence of cardiovascular and has good myocardial protecti0n,especially the lower-dose ulinastatin was better than high-dose in clinical practice.

关 键 词：乌司他丁 七氟醚 吸入麻醉 冠状动脉旁路移植术 非体外循环 

分 类 号：R654.2[医药卫生—外科学]