不同剂量舒芬太尼对心肺转流风湿性心脏病瓣膜置换术患者围术期心肌损伤的影响  

Study on the influence of different dosages of fentanyl on heart turn flow wind perioperative myocardial injury in patients with heart valve replacement by cardiopulmonary bypass

作　　者：许艳军[1] 许继元[1] 李家琼[1] 孙胜利[1] 张先江[1] 王志栋[1] 丁文平[2] 吴从友[2] 

机构地区：[1]江苏省徐州市中心医院ICU,江苏徐州221009 [2]江苏省徐州市中心医院麻醉科,江苏徐州221009

出　　处：《临床和实验医学杂志》2016年第23期2380-2383,共4页Journal of Clinical and Experimental Medicine

摘　　要：目的观察并对比不同剂量舒芬太尼对心肺转流（CPB）风湿性心脏病瓣膜置换术患者围术期心肌损伤的影响。方法将60例确诊为风湿性心脏病需择期行瓣膜置换术患者随机分为3组,即对照组（生理盐水）、低剂量舒芬太尼组（0.05μg/kg,R1组）、高剂量舒芬太尼组（0.08μg/kg,R2组）,监测三组患者全身麻醉诱导前（T0）、CPB后2h（T1）、CPB后24 h（T2）、CPB后48 h（T3）、CPB后72 h（T4）各时间点的血浆肌钙蛋白（c Tn I）、肌酸激酶同工酶（CKMB）、平均动脉压（MAP）和心率（HR）并对比以上指标的差异。结果 R1组在T1时刻HR、CK-MB较对照组明显降低;R2组T1时刻HR较T0时刻明显降低,T1-T2时刻CK-MB较T0时刻明显降低,T2-T4时刻c Tn I较T0-T1时刻明显降低;R1组术后24 h心肌收缩力评分、心血管不良事件发生率显著低于对照组（P均〈0.05）,心脏自动复跳率与对照组比较未见显著差异（P〉0.05）;R2组术后24 h心肌收缩力评分、心血管不良事件发生率、心脏自动复跳率均优于R1组（P均〈0.05）。结论 0.05-0.08μg/kg剂量范围内的舒芬太尼对心肺转流风湿性心脏病瓣膜置换术患者围术期心肌损伤有较好的保护作用,高剂量[0.8μg/kg舒芬太尼麻醉诱导＋0.5μg/（kg·min）麻醉维持]效果更优。Objective To observe and compare the influence of different dosages of fentanyl on heart turn flow wind heart valve replacement in patients with perioperative myocardial injury under cardiopulmonary bypass （CPB）. Methods A total of 60 patients with rheumatic heart disease undergoing valve replacement were randomly divided into 3 groups ： control group （ with saline） , low dosage sufentanil group （0.05 g /kg, R1 group） and high dosage sufentanil group （0.08 g/kg, R2 group） , patients in these three groups under general anesthesia induced by monitoring before （T0） and CPB 2h （T2 ） , CPB 24 h （T2 ） , CPB 48h （ T3） and CPB 72h （ T4 ） , plasma troponin at each time point （ cTn1） , creatine kinase isoenzyme （CK - MB） , mean arterial pressure （MAP） , heart rate （HR） , and the difference in these above indexes had been compared. Results In group R1, HR and CK - MB at time point Tj , HR was significantly lower than that of control group. In R2 group at , HR com-pared with TO was significantly decreased, at T2 time points, CK - MB was significantly decreased compared with that of TO time point, cTnl inT2 -T4 in comparison with Tj -T0 was significantly reduced. The myocardial contractility scores in R1 group after 24 h and incidence of cardiovascular adverse events were significantly lower than those of control group （ P 〈 0 .0 5 ） , and there was no significant difference in automatic rebeating rate had been observed in control group （ P 〉 0 .0 5 ） . The contractility scores in R2 group in 24 h after the operation, the incidence rate of cardiovascular events and automatic rebeating rate in R2 group were better than those of group R1 （ P 〈 0 .0 5 ） . Conclusion The range of dosages of fentanyl at 0. 05 -0.08 μg/kg has better protective effect on perioperative myocardial injury in heart turn wind flow in patients with heart valve replacement, and the effect of high

关 键 词：风湿性心脏病 瓣膜置换术 心肺转流术 舒芬太尼 心肌保护 

分 类 号：R614[医药卫生—麻醉学]