三种全麻方式对二尖瓣置换术患者心肌功能影响的比较  

The effect of different general anesthesia methods on myocardial function in mitral valve replacement patients

作　　者：赵佑君[1] 顾尔伟[2] 朱德浩[1] 李晓红[1] 陈庆书[3] 李卫鹏[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：《临床麻醉学杂志》2013年第4期347-349,共3页Journal of Clinical Anesthesiology

摘　　要：目的比较丙泊酚、七氟醚及丙泊酚复合七氟醚全麻对二尖瓣置换术患者缺血-再灌注心肌功能的影响。方法择期行心肺转流(CPB)二尖瓣置换术患者45例,随机均分为三组,分别采用丙泊酚(P组)、七氟醚(S组)或丙泊酚复合七氟醚(PS组)全麻。于麻醉诱导前(T0)、升主动脉开放后2h(T1)、4h(T2)、8h(T3)、24h(T4)、48h(T5)采集动脉血测定心肌肌钙蛋白I(cTnI)和丙二醛(MDA)浓度、肌酸激酶同工酶(CK-MB)和超氧化歧化酶(SOD)活性。结果与T0时比较,T1～T5时三组血浆cTnI浓度、CK-MB活性明显升高(P<0.05);T1～T4时三组血浆MDA浓度升高,而SOD活性明显降低(P<0.05)。与S组比较,T1～T5时P组、PS组血浆cTnI浓度、T2～T5时CK-MB活性明显升高(P<0.05);T1～T4时血浆MDA浓度明显升高,而SOD活性明显降低(P<0.05)。结论在CPB下行二尖瓣置换术七氟醚维持麻醉有更好的心肌保护作用。Objective To compare the effect of different anesthesia method with propofol, sevoflurane or propofol combined with sevoflurane on myocardial injury in the mitral valve replacement surgery patients. Methods Forty-five patients were randomly assigned to propofol group （group P）, sevoflurane group （group S）, or propofol combined with sevoflurane group （group PS） with 15 cases each. Arterial blood levels of cTnI, CK-MB, MDA and SOD were determined at pre- induction （To）, 2 h （T1）, 4 h （T2）, 8 h （T3）, 24 h （T4） and 48 h （Ts） after unclamping of aorta. Results The plasma levels of cTnI and CK-MB were significantly increased at T1-T2 compared with To. The plasma SOD concentration was significantly decreased and MDA increased at T1-T4 （P 〈 0. 05）. Compared with group S, the plasma cTnI concentration at T1-T5 and CK-MB at T2-T5 decreased, MDA at T1-T4 increased and SOD decreased in group P and PS（P〈0. 05）. Conclusion Sevoflurane anesthesia is beneficial for myocardial protection in mitral valve replacement surgery patients.

关 键 词：丙泊酚 七氟醚 心肌保护 缺血-再灌注损伤 

分 类 号：R614[医药卫生—麻醉学]