七氟醚联合胸段硬膜外阻滞对非体外循环冠状动脉搭桥术患者心肌损伤的影响  

Effect of sevoflurane combined with thoracic epidural anesthesia on myocardial injury in patients undergoing off-pump coronary artery bypass grafting

作　　者：张义轩[1] 闫增[1] 信文启[1] 张挚[1] 马传根[1] 

机构地区：[1]河南大学淮河医院麻醉科,开封475000

出　　处：《中华实验外科杂志》2014年第5期1135-1137,共3页Chinese Journal of Experimental Surgery

摘　　要：目的观察七氟醚联合胸段硬膜外阻滞对非体外循环冠状动脉搭桥术（OPCABG）患者心肌损伤的影响。方法拟行OPCABG患者40例，性别不限，年龄〈60岁，美国麻醉医师协会评分标准（ASA）分级Ⅱ或Ⅲ级，采用随机数字表法，将患者随机分为2组（n=20）：对照组（C组）和实验组（SE组），每组20例。SE组于T4～T5间隙行硬膜外穿刺，穿刺成功后向头端置入硬膜外导管4cm，固定硬膜外导管。SE组患者于气管插管后吸入七氟醚并维持呼气末浓度1．5％，同时硬膜外注入0．25％左布比卡因5mVh直至手术结束。分别于麻醉前（T0）、术毕（T1）、术后4h（T2）、8h（T3）、12h（T4）和24h（T5）时，采集中心静脉血样4ml．，测定血浆心肌肌钙蛋白I（cTnI）浓度、肌酸激酶（CK）和肌酸激酶同功酶（CK—MB）的活性。结果T2～T5时血浆cTnI浓度分别为：（5．45±1．85）、（7．34±1．88）、（7．29±1．86）、（6．85±1．89）μg/L，与C组比较，SE组T2-T5时血浆cTnI浓度降低；T2～T5时血浆CK浓度分别为：（35±5）、（42±8）、（54±9）、（52±9）U／L，与C组比较，SE组血浆CK浓度降低（P〈0．05）；T2～T5时血浆CK—MB浓度分别为：（3．4±1．1）、（4．6±1．9）、（3．8±1．5）、（1．5±0．8）U／L，与C组比较，SE组血浆CK—MB浓度降低（P〈0．05）。结论七氟醚联合胸段硬膜外阻滞可减轻OPCABG患者心肌的损伤。Objective To investigate the effects of sevoflurane combined with thoracic epidural anesthesia on myocardial injury in patients undergoing off-pump coronary artery bypass grafting. Methods Forty consenting USA society of Anesthesiologists score standard （ASA） Ⅱ or Ⅲ patients undergoing offpump coronary artery bypass grafting were randomly divided into 2 groups （ n = 20 each） ： The patients in SE group were given thoracic epidural anesthesia plus general anesthesia with 0. 25% levobupivaeaine hydrochloride injection as the study group. The patients in the control group received general anesthesia only. 4 ml of blood samples were taken from the central vein before skin incision （ TO ） , at the end of operation （ T1 ） , and 4 h （T2 ）, 8 11 （T3 ）, 12 h （T4 ） and 24 h （T5 ） after operation for determination of the concinase （CK） and ereatin kinase isoenzyme-MB （CK-MB）. Results The concenentration of serum cardiac troponin I （cTnI） at T2-T5 was （5.45 ± 1.85）, （7. 34 ± 1.88）, （7.29 ± 1.86） and （6. 85 ± 1.89） μg/L respectively in SE group, significantly lower than in the control group. The coneenentration of serum CK at T2-T5 was （35 ±5）, （42 ±8）, （54 ±9） and （52 ±9） U/L, significantly lower in SE group than in the control group （P 〈0. 05）. The concenentration of serum CK-MB at T2-T5 was （3.4 ± 1.1 ）, （4. 6 ± 1.9）, （3.8 ± 1.5） and （ 1.5 ± 0. 8 ） U/L respectively, significantly lower in SE group than in the control group （ P 〈 0. 05 ）. Conclusion Sevoflurane combined with thoracic epidural anesthesia can attenuate the myocardial injury in patients undergoing off-pump coronary artery bypass grafting.

关 键 词：七氟醚 硬膜外阻滞 非体外循环冠状动脉搭桥术 心肌损伤 

分 类 号：R614[医药卫生—麻醉学]