七氟醚预处理对体外循环冠状动脉旁路移植术患者左心室功能的影响  

Effect of sevoflurane preconditioning on left ventricular function in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass

作　　者：赵雅梅[1] 史宏伟[1] 缪娟娟[1] 王振红[1] 葛亚力[1] 魏海燕[1] 陈鑫 

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)麻醉科, 210006 [2] 南京市心血管病医院心胸外科

出　　处：《中华麻醉学杂志》2013年第12期1423-1426,共4页Chinese Journal of Anesthesiology

基　　金：基金项目：南京市卫生青年人才培养工程（第一层次）,宁卫科[2011]42号

摘　　要：目的 评价七氟醚预处理对体外循环（CPB）冠状动脉旁路移植术（CABG）患者左心室功能的影响.方法 择期CPB下行CABG患者30例,年龄42 ～ 70岁,身高152～ 181 cm,体重43 ～ 78 kg,ASA分级Ⅱ或Ⅲ级.采用随机数字表法,将其分为2组（n=15）：对照组（C组）和七氟醚预处理组（SP组）.SP组在气管插管后吸入呼气末浓度相当于1 MAC七氟醚30 min.于七氟醚预处理前（T0）和停CPB后60 min（T1）时记录平均动脉压、每搏量指数、肺动脉阻塞压和TEE监测指标：左心室射血分数、E波、S波、D波的峰值和左心室舒张早期血流播散速度,计算S波与D波峰值比、E波与Vp的比值.记录气管导管拔除时间和ICU停留时间.结果 与T0时比较,2组T1时HR升高（P＜0.05或0.0.01）,余左心室功能指标差异无统计学意义（P＞0.05）;与C组比较,SP组左心室功能各指标、气管导管拔除时间和ICU停留时间差异无统计学意义（P＞0.05）.结论 CPB前吸入呼气末浓度1 MAC七氟醚预处理在左心室功能方面没有明显的心肌保护作用,对短期预后也无明显影响.Objective To evaluate the effect of sevoflurane preconditioning on the left ventricular function in patients undergoing coronary artery bypass grafting （CABG） with cardiopulmonary bypass （CPB）.Methods Thirty ASA physical status Ⅱ or Ⅲ patients,aged 42-70 yr,with body height 152-181 cm,weighing 43-78 kg,scheduled for elective CABG under CPB,were randomly divided into 2 groups （n =15 each） using a random number table：control group （group C） and sevoflurane preconditioning group （group SP）.Group SP inhaled sevoflurane with the end-tidal concentration corresponding to 1 MAC for 30 min after endotracheal intubation.Before sevoflurane preconditioning （T0） and at 60 min after termination of CPB （T1）,mean arterial pressure （MAP）,stroke volume index （SVI）,pulmonary artery obstruction pressure and the TEE variables including left ventricular ejection fraction （LVEF）,peak E wave velocity （E）,systolic wave velocity （S）,and diastolic wave velocity （D）,and low propagation velocity （Vp） were recorded.S/D ratio and E/Vp ratio were calculated.Extubation time and duration of ICU stay were also recorded.Results Compared with the baseline value at T0,HR was significantly increased at T1 （P 〈 0.05 or 0.01）,and no significant change was found in the other parameters of the left ventricle function in the two groups （P 〉 0.05）.There was no significant difference in the parameters of the left ventricle function,extubation time and duration of ICU stay between SP group and C group （P 〉 0.05）.Conclusion Preconditioning with inhalation of sevoflurane with the end-tidal concentration corresponding to 1 MAC before CPB does not produce myocardial protection in terms of the left ventricular function or exerts little effect on the short-term outcomes.

关 键 词：麻醉药 吸入 缺血预处理 心脏功能试验 冠状动脉分流术 心肺转流术 

分 类 号：R614[医药卫生—麻醉学]