咪唑安定及异丙酚对心内直视手术患者心肌缺血/再灌注损伤的保护作用  

Protective effects of midazolam and propofol on myocardial ischemic reperfusion injury in patients undergoing open heart surgery

作　　者：常业恬[1] 刘流[1] 周建美[1] 谢才姣[1] 陈启智[1] 吕志平[1] 李李[1] 

机构地区：[1]湖南医科大学附属第二医院麻醉学教研室,长沙410011

出　　处：《中华麻醉学杂志》2000年第8期456-458,共3页Chinese Journal of Anesthesiology

基　　金：湖南省科委资助!项目 (编号 :0 1 95 2 80 3 )

摘　　要：目的　比较等效麻醉剂量的咪唑安定、异丙酚对心内直视手术心肌缺血再灌注损伤的保护作用。方法　将 36例室间隔缺损择期行心内直视手术患者分为三组 ,咪唑安定组 (M组 )、异丙酚组 (P组 )和未阻断主动脉组 (N组 ) ,每组 12例。诱导前M组、N组静注咪唑安定 0 2mg·kg-1,P组静注异丙酚 2 0mg·kg-1;诱导后M组、N组用微泵静注咪唑安定 0 4mg·kg-1·h-1,P组静注异丙酚 4 0mg·kg-1·h-1。在转流开始时 ,开放主动脉后 30min、4、12、2 4h取血测心肌酶活性 ,并记录心脏复跳的方式、心律失常、用升压药的例数。结果　与转流开始比较 ,三组患者开放主动脉后均明显升高 (P <0 0 5或 0 0 1)。开放主动脉后血清心肌酶活性M组明显高于P组 (P <0 0 5 ) ,需电击复跳、心律失常 ,需用升压药维持的例数M组多于P组 ;开放主动脉后血清心肌酶活性P组、M组均高于N组 (P <0 0 5或 0 0 1) ,需电击复跳、心律失常用升压药的例数亦多于N组。结论　异丙酚减轻心内直视手术心肌缺血再灌注损伤的作用明显强于等效剂量的咪唑安定。Objective To compare the protective effects of midazolam and propofol at equivalent dose on myocardial ischemia reperfusion injury during open heart surgery Methods Thirty six patients,scheduled for elective open heart surgery, were divided into midazolam (M), propofol (P) and no occluding (N) groups Before induction, a bolus of midazolam 0 2mg·kg -1 was given in group M or N , and a bolus of propofol 2 0mg·kg -1 in group P; after induction, midazolam was infused at 0 4mg·kg -1 ·h -1 in group M or N , and propofol at 4 0mg·kg -1 ·h -1 in group P The arterial blood samples were taken to measured the activities of serum enzymes ,at the beginning of CPB, 30min, 4, 12 and 24h after release of the aortic cross clamp Results As compared with those at at the beginning of CPB, the activities of serum enzymes increased significantly in three groups following declamping (P<0 05 or 0 01) After declamping, the activities of serum enzymes in group M were significantly higher than those in group P (P<0 05) The incidence of restoring spontaneous heart beat was obviously lower and dopamine required rate was markedly higher in group M than those in group P The activities of serum enzymes and dopamine required rate in group P and M were higher, and the incidence of restoring spontaneous heart beat was lower than those in group N Conclusions Propofol reduce myocardiac ischemia reperfusion injury much more than equivalent dose of midazolam undergoing open heart surgery

关 键 词：咪唑安定 异丙酚 心内直视手术 心肌再灌注损伤 

分 类 号：R614[医药卫生—麻醉学]