七氟醚维持麻醉对心脏瓣膜置换术患者血清超敏肌钙蛋白I、IL-6和TNF-α的影响  

Effects of sevoflurane for maintaining anesthesia on serum ultra-sensitive troponin I,interleukin-6 and tumor necrosis factor alpha in patients undergoing cardiac valve replacement surgery

作　　者：胡媛媛[1] 吕洁萍[2] 田首元[2] 高素琴[1] 李婧[1] 

机构地区：[1]山西医科大学麻醉学系,太原030001 [2]山西医科大学第一临床医学院麻醉科

出　　处：《山西医科大学学报》2014年第4期325-328,共4页Journal of Shanxi Medical University

摘　　要：目的通过观察七氟醚维持麻醉对心脏瓣膜置换术患者血清超敏肌钙蛋白I(hs-cTnI)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)浓度的影响,探讨其对心肌的保护作用。方法采用随机对照研究方法,将36例择期在体外循环下行单瓣膜置换术的风湿性心脏病患者,分为七氟醚组(S组)和对照组(C组),每组18例。七氟醚组以吸入七氟醚维持麻醉,对照组以静脉泵注芬太尼和咪达唑仑维持麻醉。整个手术中维持脑电双频指数(BIS)40-55。检测术前(T1)、主动脉开放时(T2)、主动脉开放2 h(T3)、24 h(T4)后血清中hs-cTnI、IL-6和TNF-α的浓度。结果在T1和T2时两组血清中hs-cTnI、IL-6和TNF-α浓度在组内和组间的差异均无统计学意义(P>0.05);在T3、T4时两组血清中hs-cTnI、IL-6、TNF-α浓度均较T1和T2时升高(P<0.05);在T3、T4时血清中hs-cTnI、IL-6、TNF-α浓度S组均明显低于C组(P<0.05)。结论七氟醚维持麻醉能明显减轻瓣膜置换术中心肌缺血-再灌注损伤,其机制可能与抑制炎性因子的产生有关。Objective To investigate the effects of sevoflurane for maintaining anesthesia on serum high-sensitive troponin I （hs-cT- nI）, interleukin-6 （IL-6） and tumor necrosis factor alpha （TNF-ct） in patients undergoing cardiac valve replacement surgery, and to explore its protective effects on myocardium. Methods Thirty-six rheumatic heart disease patients scheduled for cardiac valve re- placement surgery in cardiopulmonary bypass,were randomly assigned into two groups （n = 18 in each group） ：sevoflurane group and fentanyl and midazolam group. BIS was maintained at 40 -50 during the whole surgery. The blood samples were collected to detect the serum levels of hs-cTnI, IL-6 and TNF-α before surgery （T1 ）, at the time of aortic unclamping （T2 ）,2 h （T3 ） and 24 h （T4 ） after aortic unclamping. Results There was no significant difference in levels of hs-cTnI,IL-6 and TNF-α between two groups at T1 and T2 （ P 〉 0.05 ）. Levels of hs-cTnI, IL-6 and TNF-α were higher at T3 and T4 in both groups than at Tl and T2 respectively （ P 〈 0.05 ）, and they were significantly lower at T3 and T4 in sevoflurane group than in fentanyl and midazolam group （ P 〈 0. 05 ）. Conclusion Sevoflurane could alleviate the ischemia/reperfusion injury in patients undergoing rheumatic cardiac valve replacement surgery, which may be related to the inhibition of inflammatory factors.

关 键 词：七氟醚 瓣膜置换术 超敏肌钙蛋白I 炎性因子 

分 类 号：R614[医药卫生—麻醉学]