地氟烷对不停跳冠状动脉搭桥术患者血流动力学和心肌保护的影响  

The effect of desflurane on hemodynamics and myocardial protection in patients undergoing off - pump coronary artery bypass grafting surgery

作　　者：郭迎春[1] 张雪亚[2] 张立[1] 

机构地区：[1]河南省胸科医院手术室,郑州450003 [2]河南省胸科医院心血管科,郑州450003

出　　处：《中华实验外科杂志》2017年第4期685-687,共3页Chinese Journal of Experimental Surgery

摘　　要：目的 观察地氟烷对不停跳冠状动脉搭桥术（OPCABG）患者血流动力学和心肌保护的影响。 方法 将行OPCABG 50例患者，随机分为地氟烷组（D组，n＝25）和丙泊酚组（P组，n＝25）。全组患者麻醉前30 min肌注吗啡10 mg，咪达唑仑3～5 mg；全组患者应用依托咪酯0.1～0.2 mg/kg、罗库溴铵0.6 mg/kg和舒芬太尼1～2 μg/kg麻醉诱导；麻醉维持泵注舒芬太尼0.5～1.0 μg/（kg·h）、顺式阿曲库铵0.5～1.0 mg/（kg·h），D组吸入地氟烷0.7～1.5 MAC，P组泵注丙泊酚2～8 mg/（kg·h）。经桡动脉，右颈内静脉穿刺测压，监测围术期各时段心脏指数（CI）、心率（HR）、血压（ABP）、右房压（CVP）、肺动脉压（PAP）、肺动脉楔压（PAWP），麻醉中脑电双频指数（BIS）值维持在40～60，术中常规监测体温和尿量。分别于麻醉前、术后6、12、24、36 h抽取静脉血，测定血浆肌钙蛋白Ⅰ（cTnⅠ）及肌酸激酶同工酶（CK-MB）水平。 结果 手术后6 h各组均出现CK-MB和cTnⅠ释放量增加，术后24 h D组cTnⅠ释放量明显低于P组[（0.77±0.38）比（0.96±0.42），P＝0.034]，同时D组CK-MB释放量也较低[（23.79±5.96）比（28.13±7.51），P＝0.042]。结论 在OPCABG麻醉过程中，地氟烷复合麻醉可减轻心肌损伤达到保护心肌的作用，减少升压药的使用率。Objective To evaluate the effect of desflurane on hemodynamics and myocardial pro- tection in patients undergoing offpump coronary artery bypass grafting surgery （OPCABG）. Methods Fifty patients, scheduled for OPCABG, were randomly assigned to two groups： the desflurane group （D group,n =25） and the propofol group （P group, n =25）. For all patients, 10 mg morphine and 3 -5 mg midazolam were intramuscularly injected before anesthesia. 0. 1 -0. 2 mg/kg etomidate was used for anes- thesia induction followed by rocuronium 0. 6 mg/kg and sufentanil 1 - 2μg/kg for all patients, for all pa- tients, sufentanil 0. 5 - 1.0 μg/（ kg. h） and Cisatr - curium 0. 5 - 1.0 mg/（ kg·h） were maintained. Desflurane 0. 7 - 1.5 MAC was maintained in D group. Propofol 2 - 8 mg/kg was maintained in P group. Manometry was conducted through puncture in radial artery and right internal jugular vein for all patiens. The changes in cardiac index （CI）, heart rate （HR）, blood pressure （ABP）, right atrial pressure （CVP）, pulmonary arterial pressure （PAP） and pulmonary artery wedge pressure （PAWP） were moni- tored perioperatively. Bispeetral index （BIS） was maintained at 40 - 60. Temperature and urine were mo- nitorred routinely. Before and 6, 12, 24 and 36 h after operation, blood samples were collected to measure troponin I （ cTnI ） and creatine kinase isoenzyme （ CK - MB）. Results Plasma cTn I and CK - MB levels in postoperative period were higher than the preoperative baseline in both groups, cTn I and CK - MB level were significantly higher in P group than in D group [ （0. 77±0. 38） vs. （0. 96 ±0.42） , P=0.034; （23.79 ±5.96） vs. （28. 13 ±7.51）, P=0.042].Conclusion Our results suggest that desflurane combined sufentanil anesthesia provides better management of reduced myocardial injury and less intropie agents usage in OPCABG.

关 键 词：地氟烷 不停跳冠状动脉搭桥术 血流动力学 心肌保护 

分 类 号：R614[医药卫生—麻醉学]