丙泊酚与七氟醚单用或联用对缺血-再灌注心肌功能的影响  

Research The Influence of Propofol,Sevoflurane Alone or Their Combination on IRI

作　　者：刘延芹[1] 石磊[1] 李浩[1] 赵海涛[1] 李素玲[1] 徐龙河[2] 

机构地区：[1]河北省儿童医院,河北石家庄050031 [2]中国人民解放军总医院,北京100853

出　　处：《中国药业》2015年第15期8-10,共3页China Pharmaceuticals

摘　　要：目的研究七氟醚、丙泊酚单用或联用对缺血-再灌注心肌功能的影响。方法选择2011年9月至2014年12月医院行二尖瓣置换术的风湿性心脏病患者168例,按随机数字表法分为A组、B组和C组,各56例。3组常规麻醉诱导后,A组采用七氟醚1.0～1.5最低有效肺泡浓度（MAC）全程吸入维持,B组采用丙泊酚1.5～2.0 mg/L维持,C组给予丙泊酚0.5～1.0 mg/L全程靶控输注＋七氟醚0.5 MAC维持;所有患者持续静脉泵注瑞芬太尼镇痛,间断追加维库溴铵维持肌松。结果 3组患者血流动力学指标心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）稳定,各时间点肌钙蛋白I（c Tn I）和肌酸磷酸激酶同工酶（CK-MB）均明显高于诱导前（P〈0.05）;A组c Tn I水平在T1,T2,T3,T4各时间点,CK-MB活性在T2,T3,T4各时间点明显低于B、C组（P〈0.05）;A组术后心脏自主复跳率、气管导管拔除时间及心肌收缩力评分均优于B、C组,复跳后心律失常发生率低于B、C组（P〈0.05）;3组住院时间无明显差异（P〉0.05）。结论七氟醚、丙泊酚单用或联用在体外循环直视下瓣膜置换手术麻醉中均可维持血流动力学稳定,满足手术需求。其中七氟醚单用在体外循环转流期间对心肌具有保护作用,且术后恢复好,复跳后心律失常发生率低。Objective Research the influence of Propofol, sevoflurane alone or their combination on IRI. Methods 168 cases of rheumat-ic heart disease who underwent mitral valve replacement were chosen randomly from September 2011 to December 2014 and divided into A,B,C group, 56 cases in each group, after three conventional induction of anesthesia, A group with sevoflurane 1. 0 - 1. 5 minimum alveolar concentration effective （ MAC） to maintain full inhalation, B group with propofol 1. 5 - 2. 0 mg / L maintain the combined group given propofol 0. 5 - 1. 0 mg / L throughout the target - controlled infusion ＋ 0. 5 MAC sevoflurane maintain; all patients by continuous in-travenous infusion of remifentanil analgesia, intermittent chase Garvey library bromine ammonium maintain muscle relaxants. Observed and recorded hemodynamic parameters （HR, MAP and CVP） changes; measuring cardiac function; records in each group of patients and hos-pital postoperative recovery time. Results Three groups of patients hemodynamically stable; three groups of patients at each time point cTnI and CK - MB activity levels were significantly higher than before induction（ P〈 0. 05）; sevoflurane cTnI level in T1, T2, T3, T4 each time point significantly lower than the B, C group, sevoflurane CK - MB activity in T2, T3, T4 at each time point was significantly lower than the B, C group（ P〈 0. 05）; A group after cardiac autonomic resuscitation rate, extubation time and inotropic scores were bet-ter than the B, C group; A group after resuscitation lower incidence of arrhythmias B, C group（ P〈 0. 05）; three groups of hospital stay was no significant difference（ P〉 0. 05） . Conclusion Sevoflurane and propofol alone and in combination with cardiopulmonary bypass in valve replacement surgery under anesthesia can maintain hemodynamic stability, to meet the need for surgery, including sevoflurane alone during cardiopulmonary bypass on myocardium has a protective effect, and postoperative recovery, and a low incidence of arrhythmias

关 键 词：丙泊酚 七氟醚 缺血-再灌注损伤 体外循环 肌钙蛋白I 肌酸磷酸激酶同工酶 

分 类 号：R969.4[医药卫生—药理学] R971.2[医药卫生—药学]