阿片类药物对心脏手术患者cTnⅠ、IL-6的影响  

The influence of opioid to troponin Ⅰ , and IL-6 in patients undergoing cardiac surgery

作　　者：谭义文[1] 田毅[1] 林赛娟[1] 黄运佰[1] 蔡仁贤[1] 侯春燕[1] 

机构地区：[1]中南大学湘雅医学院附属海口医院麻醉科,海口市人民医院麻醉科,海口570208

出　　处：《中国医师杂志》2016年第8期1158-1161,共4页Journal of Chinese Physician

基　　金：海南省卫生厅科研基金资助项目（琼卫2009-75）

摘　　要：目的 观察心脏瓣膜置换术患者心肌肌钙蛋白Ⅰ （cTn Ⅰ）、白介素-6（IL-6）的变化,比较瑞芬太尼、舒芬太尼和芬太尼对该类患者心肌保护及炎症抑制的程度.方法 选择心脏换瓣术患者48例,按随机数字表法分为三组（n=16）：瑞芬太尼组（R组）、舒芬太尼组（S组）和芬太尼组（F组）.三组患者均全凭静脉麻醉,麻醉药包括咪达唑仑、阿片类药物、丙泊酚、维库溴铵;三组患者的阿片类药物分别是：R组静脉注射瑞芬太尼1～2 μg/kg诱导,1～4 μg/（kg＆#183;min）维持麻醉;S组静脉注射舒芬太尼1～2tμg/kg诱导,1～4 μg/（kg＆#183;h）维持麻醉;F组静脉注射芬太尼5～ 10 μg/kg诱导,10～ 30μg/（kg＆#183;h）维持麻醉;分别于麻醉前（T0）,升主动脉开放后20 min（T1）,术毕时（T2）,体外循环停止后6 h（T3）和24 h（T4）抽静脉血测cTnⅠ、IL-6浓度.结果 与T0比较,三组cTn Ⅰ、IL-6在T1、T2、T3持续递增（P＜0.05）,cTn Ⅰ于T4达到峰值（P＜0.05）,IL-6在T3达到峰值（P＜0.05）;与F组比较,R组和S组cTn Ⅰ、IL-6于T1、T2、T3和T4均明显较低（P＜0.05）.结论 在减轻瓣膜置换术患者心肌损伤及炎症反应方面,舒芬太尼和瑞芬太尼比芬太尼的作用更具优势.Objective To investigate the change of cardiac troponin Ⅰ （cTn Ⅰ）,interleukin （IL）-6 in patients undergoing cardiac valve replacement and compare the degrees of fentanil,sufentanil,and remifentanil on myocardial protection and inhibiting effect of inflammatory.Methods Forty-eight patients,undergoing cardiac valve replacement,were randomly divided into three groups （n =16）：remifentanil （group R）,sufentanil （group S）,and fentanil （group F）.All the patients were total intravenous anesthesia of midazolam,opioid,vecuronim,and propofol.Different opioids were used in each group.Group R was induced with remifentanyl 1 ～2 μg/kg and maintained at a rate of 1 ～4 μg/（kg ＆#183; min）.Group S was induced with sufentanyl 1 ～2 μg/kg and maintained at a rate of 1 ～4 μg/（kg ＆#183; h）.Group F was induced with fentanyl 5 ～ 10 μg/kg and maintained at a rate of 10 ～30 μg/（kg ＆#183; h）.Blood samples were taken before anesthesia （T0）,twenty minutes after aortic declamping （T1）,the end of operation （T2）,6 h （T3）,and 24 h （T4） after cardiopulmonary bypass （CPB） for determination of plasma concentration of troponinⅠ and IL-6.Results Compared to T0,cTn Ⅰ and IL-6 in three group at T1,T2,T3 were significantly higher （P 〈 0.05）,cTn Ⅰ reached the peak level at T4 （P 〈 0.05）,IL-6 reached the peak level at T3 （P 〈 0.05）.Compared to group F,cTn Ⅰ and IL-6 in groups S and R at T1,T2,T3,and T4 decreased significantly （P 〈0.05）.Conclusion Compared to fentanil,sufentanil and remifentanil had comparative advantages on lessening myocardial injury and inhibiting effect of inflammatory for patients who are undergoing cardiac valve replacement.

关 键 词：芬太尼/药理学 舒芬太尼/药理学 心脏瓣膜假体植入 肌钙蛋白Ⅰ/代谢 白细胞介素6/代谢 

分 类 号：R614[医药卫生—麻醉学]