七氟醚预处理对CVR患者血清炎性细胞因子和心肌酶的影响  

Effects of sevoflurane preconditioning on inflammatory cytokine and myocardial enzyme in patients undergoing cardiac valve replacement

作　　者：朱辉[1] 李辉[1] 杨进国[1] 孔俊丽[1] 吴清海[1] 金琪[1] 

机构地区：[1]湖北医药学院附属东风医院,湖北十堰442000

出　　处：《现代中西医结合杂志》2015年第25期2743-2746,共4页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：湖北省教育厅青年基金项目(Q20122404);湖北省科技厅自然科学基金项目(2012FFC004);十堰市科学技术研究与开发项目(ZD2011033)

摘　　要：目的 观察七氟醚（Sev）预处理对体外循环下心脏瓣膜置换术（CVR）患者血清炎性细胞因子和心肌酶的影响,探讨其对心脏保护作用的可能机制。方法 选择择期行CVR患者60例,ASAⅡ-Ⅲ级,随机分为对照组（C组）和Sev预处理组（S组）,每组30例。S组在麻醉诱导后吸入1.0%的Sev,30 min后洗脱,至体外循环（CPB）开始时使呼气末Sev浓度均〈0.1%。用丙泊酚、咪达唑仑、舒芬太尼、维库溴铵维持麻醉,BIS值保持在40-50。C组不吸入Sev,其余用药同S组。分别于麻醉前（t0）、主动脉开放时（t1）、主动脉开放后2 h（t2）及术后24 h（t3）采集桡动脉血,检测血清IL-6、IL-8、TNF-α、c Tn I、CK、CK-MB水平。结果 t2和t3时,2组血清IL-6、IL-8和TNF-α水平均较t0和t1时明显升高（P均〈0.05）,t3时较t2时明显降低（P均〈0.05）,S组t2和t3时均明显低于C组（P均〈0.05）;t0时2组血清c Tn I、CK和CK-MB水平均在正常范围,t1-t3时明显升高（P均〈0.05）,S组t1-t3时血清c Tn I水平均明显低于C组（P均〈0.05）。结论 七氟醚预处理能明显减轻CVR患者的心肌缺血再灌注损伤,其心肌保护作用机制可能与抑制炎性因子的产生和减少心肌酶的释放有关。Objective It is to investigate the effect of sevoflurane （ Sev） preconditioning on inflammatory cytokine and car-diac enzyme in the patients undergoing cardiac value replacement （ CVR ） and to explore the mechanism of Sev protecting heart.Methods A total of 60 ASAⅡ-Ⅲ patients under cardiopulmonary bypass for CVR ,were randomly assigned into 2 groups （n=30）：control group（group C） and Sev preconditioning group（group S）.Group S received 1.0% Sev after anes-thesia induction lasting for 30 min, and then being washed out until the beginning of CPB when the end tidal concentration of Sev was lower than 0.1%.Anesthesia was maintained with propofol , midazolam, sufentanil and vecuronium , BIS was main-tained at 40-50 .Group C received the same treatment as group S but no Sev preconditioning .The artery blood samples were collected to detect the serum concentration of IL -6, IL-8, TNF-αand the plasma levels of cTnI , CK and CK-MB before anesthesia （t0）, at the time of aortic unclamping （t1）, 2h （t2） after aortic unclamping and 24h（t3） after operation, respec-tively.Results The serum concentration of IL -6, IL-8 and TNF-αwere higher at t2 and t3 in both groups than at t0 and t1 respectively（P〈0.05）, they were decreased at t3 in both groups than at t2 （P〈0.05） , they were significantly lower at t2 and t3 in group S than in group C （P〈0.05）.Plasma levels of cTnI, CK and CK-MB were within normal range at T0 in two groups, compared with t0, those in the two groups were increased significantly at t 1-t3（P〈0.05）, compared with the group C, they were significantly lower in the group S at t 1-t3.Conclusion Sev preconditioning could alleviate the ischemia /reperfusion injury in patients undergoing CVR , which may be related to the inhibition of inflammatory factors and the reducing of myocardial enzyme .

关 键 词：七氟醚 预处理 心肺转流 瓣膜置换术 炎性因子 心肌酶学 

分 类 号：R614.2[医药卫生—麻醉学]