七氟醚全凭吸入麻醉对体外循环下心脏瓣膜置换术患者心肌酶的影响  

The effects of total inhalation anesthesia with sevoflurane on myocardial enzyme in patients undergoing cardiac valve replacement surgery

作　　者：岑晴云[1] 王晟[2] 佘守章[1] 

机构地区：[1]广州医学院附属广州市第一人民医院麻醉科,510180 [2]广东省人民医院心血管病研究所麻醉科

出　　处：《临床麻醉学杂志》2013年第6期535-537,共3页Journal of Clinical Anesthesiology

基　　金：国家自然科学基金项目(30801077);广东省科技计划项目(2011B031800005)

摘　　要：目的观察体外循环下七氟醚全凭吸入麻醉对心脏瓣膜置换术患者心肌酶的影响,探讨其对心肌的保护作用。方法选择择期行心脏瓣膜置换术的风湿性心脏病患者50例,ASAⅡ或Ⅲ级,NYHAⅡ或Ⅲ级,年龄18～65岁,随机分为七氟醚吸入组(S组)和丙泊酚静脉组(C组),每组25例。S组采用七氟醚全凭吸入麻醉,维持CETSev 1 MAC,C组丙泊酚全凭静脉麻醉。分别于麻醉诱导前(T0)、主动脉开放后30min(T1)、6h(T2)、24h(T3)采集桡动脉血4ml,化学发光法测定心肌肌钙蛋白I(cTnI)、酶偶联法测定肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氨酶(LDH)浓度。结果两组患者术中MAP、HR、SpO2变化差异无统计学意义。与T0时比较,T1～T3时两组CK、CK-MB、LDH及cTnI浓度均明显升高(P<0.05);与C组比较,S组CK在T2、T3时,CK-MB和LDH在T3时,cTnI在T1～T3时均明显降低(P<0.05)。结论与丙泊酚全凭静脉麻醉比较,全凭吸入七氟醚能有效减少体外循环下心脏瓣膜置换术患者围术期心肌酶的释放,对心肌有一定的保护作用。Objective To observe the effects of sevoflurane full treatment on myocardial enzyme releasing for rheumatic heart valve replace ment patients with cardiopulmonary bypass（CPB）. Methods Fifty ASA Ⅱ or Ⅲ and NYHA class Ⅱ or Ⅲ, age 18-65 years, scheduled for rheumatic heart valve replacement surgery patients were randomly assigned to two different anesthetic protocols （n= 25 each）. Patients received a propofol based intravenous regimen in group C. Propofol was replaced by 1 Mac sevoflurane throughout the operation in group S. The blood sample was collected before anesthesia induction （T0） and 30 min （T1）, 6 h （T2） and 24 h （T3） after aorta unclamping. The plasma lactate dehydrogenase（LDH）, ereatine kinase（CK）, creatine kinase isoenzyme（CK-MB）, and cardiac troponin I（eTnI）blood concentration was meaured. Results There was no difference with MAP, HR and SpCh in both groups during operation. Comparing with To, cTnI, CK, CK-MB and LDH increased markedly at T1-T3 in both groups（P〈0. 05）. However, CK at T2-T3, CK-MB and LDH at T3 ,cTnI at T1-T3 were lower in group S than group C（P〈0.05）. Conclusion In patients undergoing rheumatic heart valve replacement surgery with cardiopulmonary bypass, sevoflurane appear to provide better myocardial protection than propofol.

关 键 词：七氟醚 心脏瓣膜置换术 心肌酶 

分 类 号：R614[医药卫生—麻醉学]