不同浓度七氟烷预处理对心脏瓣膜置换术患者心肌损伤的保护作用  

Protection of sevoflurane pretreatment in different concentrations on myocardial injury in patients underwent heart valve replacement

作　　者：郭圣东[1] 王立峰[1] 王胜钢[1] 

机构地区：[1]临沂市人民医院麻醉科,山东临沂276002

出　　处：《中华生物医学工程杂志》2017年第1期41-45,共5页Chinese Journal of Biomedical Engineering

摘　　要：目的 探讨不同浓度七氟烷预处理对心脏瓣膜置换术患者心肌损伤的影响.方法 选取2013年1月至2015年1月本院择期行体外循环（CPB）心内直视瓣膜置换术患者75例为研究对象,所有患者均有心肌梗死史,按随机数字表法分为A组（n=25）、B组（n=25）、C组（n=25）.B组患者于切皮后开始持续吸入1%七氟烷,C组患者于切皮后开始持续吸入2%七氟烷,均于主动脉阻断时停止吸入,两组患者七氟烷吸入时间不少于30 min;A组患者术中不使用吸入型麻醉药物.记录3组患者CPB时间、主动脉阻隔时间、手术时间.切皮前（T1）、主动脉阻断即刻（T2）、主动脉开放即刻（T3）、主动脉开放30 min（T4）、CPB停机后2 h（T5）、6 h（T6）、24 h（T7）记录各时点患者心率,取静脉血检测血清白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、肌酸磷酸激酶MB型同工酶（CK-MB）、心肌肌钙蛋白I（cTnI）水平.术后随访1年,记录主要心脏不良事件发生情况.结果 共70例患者完成本研究,包括A组22例、B组24例、C组24例.3组患者CPB时间、主动脉阻隔时间、手术时间组间比较,差异均无统计学意义（均P〉0.05）.与A组比较,B组、C组患者T2-T7时点血清IL-6水平降低,T2-T5时点TNF-α水平降低（均P〈0.05）.与B组比较,C组患者T3、T4时点血清IL-6、TNF-α水平降低（均P〈0.05）.与A组比较,B组患者T5-T7时点血清CK-KB、cTnI水平降低,C组患者T3-T7时点血清CK-KB、cTnI水平降低（均P〈0.05）.与B组比较,C组患者T3-T7时点血清CK-KB、cTnI水平降低（均P〈0.05）.不同时点3组患者心率组间比较,差异无统计学意义（均P〉0.05）.随访1年,3组患者主要心脏不良事件发生率差异无统计学意义（P〉0.05）.结论 2%七氟烷预处理可降低CPB心内直视瓣膜置换术患者血清炎性因子水平,具有心肌保护作用.Objective To investigate the effects of sevoflurane pretreatment in different concentrations on myocardial injury in patients undergoing heart valve replacement. Methods Seventy-five patients,who underwent elective cardiopulmonary bypass（CPB）intracardiac orthophoria valve replacement in our hospital between January 2013 and January 2015,were included as the subjects in the study. All patients had a history of myocardial infarction and were randomly divided into group A（n=25）,group B（n=25） and group C （n=25）. Group B continued to inhale 1% sevoflurane after skin incision,and group C continued to inhale 2% sevoflurane after incision. Both groups stopped inhalation at the time of aorta occlusion. The inspiratory time of sevoflurane in the two groups was not less than 30 min. Group A was not given inspiratory anesthetic drugs during the operation. The CPB time,aorta occlusion time and operation time in the three groups were recorded. The heart rates before the skin incision（T1）,and at immediate aorta occlusion（T2）,immediate aorta opening（T3）,30 min after aorta opening（T4）,2 h（T5）,6 h（T6）,24 h＆amp;nbsp;after CPB shutdown（T7）were recorded,respectively. The serum interleukin 6（IL-6）,tumor necrosis factorα（TNF-α）, creatine kinase-MB isoenzyme（CK-MB）, and cardiac troponin I（cTnI） levels were determined. All patients were followed up for 1 year after the operation,and the occurrence of major adverse cardiac events was recorded. Results A total of 70 patients completed the study,including 22 cases in group A,24 in group B and 24 in group C. There were no statistically significant differences in the CPB time, aorta occlusion time and operation time among the three groups（all P〉0.05）. Compared with group A,the serum IL-6 level was decreased during T2-T7,and the TNF-αlevel was decreased during T2-T5 in group B and group C（all P〈0.05）. Compared with group B,the serum IL-6 and TNF-α levels were decreased in group C at T3 and T4（all P〈0.05）. Compa

关 键 词：体外循环 七氟烷 心肌再灌注损伤 

分 类 号：R614[医药卫生—麻醉学]