利多卡因联合七氟醚吸入在非体外循环冠状动脉旁路移植术中的心肌保护作用及其机制  

Myocardial protective effect of lidocaine combined with sevoflurane inhalation in off-pump coronary artery bypass grafting and its mechanism

作　　者：王旭[1] 豆立冬[1] 耿红芳[1] 

机构地区：[1]河南省人民医院麻醉科,河南郑州450003

出　　处：《新乡医学院学报》2017年第7期579-582,共4页Journal of Xinxiang Medical University

基　　金：河南省科技厅科技攻关计划项目(编号:172102310101)

摘　　要：目的探讨利多卡因联合七氟醚吸入在非体外循环冠状动脉旁路移植术(OPCABG)中的心肌保护作用及其机制。方法选择2014年1月至2015年12月在河南省人民医院接受OPCABG治疗的冠状动脉粥样硬化性心脏病患者98例作为研究对象,根据麻醉方法将患者分为观察组和对照组,每组49例。观察组患者采用利多卡因静脉输注联合七氟醚吸入进行麻醉,对照组患者采用利多卡因静脉输注进行麻醉,观察2种麻醉方法对患者的心肌保护效果、2组患者临床恢复情况及炎症因子表达水平等情况。结果 2组患者术前血浆中肌红蛋白(MYO)、肌酸激酶同工酶(CKMB)及心肌肌钙蛋白I(cTnI)水平比较差异均无统计学意义(P>0.05)。2组患者术后6 h MYO、CKMB及cTnI水平均高于术前(P<0.05)。术后6 h,观察组患者血浆中MYO、CKMB及cTnI水平均明显低于对照组(P<0.05)。观察组患者机械通气时间短于对照组,心律失常、心肌梗死及心绞痛的发生率明显低于对照组(P<0.05)。2组患者术前血清中血管紧张素Ⅱ(AngⅡ)、白细胞介素-6(IL-6)、IL-8及肿瘤坏死因子-α(TNF-α)水平比较差异均无统计学意义(P>0.05)。2组患者术后24 h AngⅡ、IL-6、IL-8及TNF-α水平均高于术前(P<0.05);术后24 h,观察组患者血清中AngⅡ、IL-6、IL-8及TNF-α水平均显著低于对照组(P<0.05)。结论利多卡因静脉输注联合七氟醚吸入对行OPCABG患者具有较好的心肌保护作用,且能降低术后并发症的发生率。Objective To explore the myocardial protective effect of lidocaine combined with sevoflurane inhalation in off-pump coronary artery bypass grafting（ OPCABG） and its mechanism. Methods A total of 98 coronary heart disease patients who underwent OPCABG were selected in the Henan Provincial People＇s Hospital from January 2014 to December 2015.The patients were divided into observation group（ n = 49） and control group（ n = 49） according to the anesthesia method. The patients in the observation group were given lidocaine intravenous infusion and sevoflurane inhalation; the patients in the control group were given lidocaine intravenous infusion. The myocardial protection effect,clinical recovery and inflammatory factor levels were observed in the two groups. Results There was no statistic difference in the plasma levels of myoglobin（ MYO）,creatine kinase isoenzyme（ CKMB） and myocardial troponin（ cTnI） between the two groups before operation（ P〉0. 05）. The levels of MYO,CKMB and cTnI in the two groups at 6 hours after operation were significantly higher than those before operation（ P〈0. 05）. The plasma levels of MYO,CKMB and cTnI in the observation group were significantly lower than those in the control group at 6 hours after operation（ P〈0. 05）. The mechanical ventilation time of patients in the observation group was significantly shorter than that in the control group（ P〈0. 05）; the incidence of arrhythmia,myocardial infarction and angina pectoris of patients in the observation group were significantly lower than those in the control group（ P〈0. 05）. There was no statistic difference in the serum levels of angiotensinⅡ（ Ang Ⅱ）,interleukin-6（ IL-6）,IL-8 and tumor necrosis factor-α（ TNF-α） between the two groups before operation（ P〉0. 05）. The serum levels of Ang Ⅱ,IL-6,IL-8 and TNF-α of patients in the two groups at 24 hours after operation were significantly lower than those before operation（ P〈0. 05）. The serum levels of AngⅡ,

关 键 词：利多卡因静脉输注 七氟醚吸入 冠状动脉粥样硬化性心脏病 非体外循环冠状动脉旁路移植术 心肌保护 

分 类 号：R654[医药卫生—外科学]