舒芬太尼后处理在非体外循环冠脉搭桥手术中的心肌保护作用  

Effect of Sufentanil Postconditioning on Myocardial Protection in Patients Undergoing Off-pump Coronary Artery Bypass Graft Surgery

作　　者：张惟惟 郑月梅[2] 张冬梅[2] 温恒[1] 王萌[1] 王海滨[2] ZHANG Weiwei;ZHENG Yuemei;ZHANG Dongmei;WEN Heng;WANG Meng;WANG Haibin(Ningxia Medical University,Yinchuan 750004;Department of Anesthesiology,the General Hospital of Ningxia Medical University,Yinchuan 750004)

机构地区：[1]宁夏医科大学,银川750004 [2]宁夏医科大学总医院麻醉科,银川750004

出　　处：《宁夏医科大学学报》2018年第9期1039-1043,共5页Journal of Ningxia Medical University

基　　金：宁夏医科大学校级科研项目(2015074)

摘　　要：目的观察舒芬太尼后处理对非体外循环冠脉搭桥手术(OPCABG)患者心肌缺血再灌注损伤的影响。方法择期行OPCABG术患者60例,性别不限,ASA分级Ⅱ～Ⅳ级,心功能Ⅱ～Ⅲ级,采用随机数字表法分为芬太尼组(F组)、舒芬太尼组(S组)和舒芬太尼后处理组(SI组),每组20例,其中麻醉诱导F组用芬太尼5μg·kg-1,S组和SI组用0.5μg·kg-1舒芬太尼麻醉诱导,其余诱导药物各组相同。SI组在左冠状动脉前降支再通前5min给予0.2μg·kg-1的舒芬太尼,稀释浓度5μg·mL-1,输注时间2min,F组和S组给予等容量生理盐水,于麻醉诱导前(T1)、前降支动脉再通后(T2)、术毕(T3)和术后6h(T4)时抽取静脉血样,用ELISA测定血浆中心肌肌钙蛋白(cTnI)和心型脂肪酸结合蛋白(h-FABP)的含量。记录各组患者术前一般资料、心胸比、左室射血分数、液体出入量、血管活性药物用量、搭桥根数、手术时间,ICU停留时间,住院时间、拔管时间,计算术后24h心肌收缩力。结果三组患者年龄、性别、身高、体重、心胸比、术前LVEF值、液体出入量、术中血管活性药物(硝酸甘油、多巴胺、肾上腺素、去氧肾上腺素)用量、手术时间、搭桥根数、ICU停留时间、在院时间、拔管时间、引流量组间比较差异均无统计学意义(P均>0.05);SI组术后24h心肌收缩力与F组和S组比较均降低(P均<0.05)。F组和S组患者不同时间点血浆cTnI和h-FABP浓度变化差异均无统计学意义(P均>0.05);SI组从T1到T4血浆cTnI和h-FABP浓度呈下降趋势(P均<0.05)。T3时,SI组患者血浆cTnI浓度均低于F组和S组(P<0.05);T4时,SI组患者血浆cTnI和h-FABP浓度均低于F组和S组(P均<0.05)。组内比较,T3、T4时血浆cTnI浓度低于T1时(P均<0.05);SI组患者T4时血浆h-FABP浓度低于T1时(P<0.05)。结论舒芬太尼后处理能降低心肌酶cTnI和h-FABP的释放量,对非体外循环冠脉搭桥手术患者心肌缺血再灌注损伤可能有一定的保护作用�Objective To observe the effect of sufentanil postconditioning on myocardial ischemia/reperfusion(I/R)injury in patients undergoing off-pump coronary artery bypass graft surgery.Methods Sixty patients with OPCABG surgery were selected,gender was not limited,ASA Ⅱ~Ⅳ,cardiac function Ⅱ~Ⅲ,and divided into fentanyl group(F group),sufentanil group(S group)and sufentanil postconditioning group(SI group)by random number table method,with 20 patients in each group.Anesthesia-induced F group with fentanyl 5μg·kg^-1,S group and SI group were anesthetized with 0.5μg·kg^-1 sufentanil,and the other induced drugs were the same.In the SI group,0.2μg·kg^-1 of sufentanil was given 5min before the left anterior descending coronary artery recanalization,and the dilution concentration was 5μg·mL^-1,the infusion time was 2min.The F group and the S group were given the same volume of normal saline.Venous blood samples were taken before anesthesia induction(T1),anterior descending artery recanalized(T2),immediately after surgery(T3),and 6h after surgery(T4).Plasma cTnI and h-FABP were determined by ELISA.The preoperative general data,cardiothoracic ratio,left ventricular ejection fraction,fluid inflow and outflow,vasoactive drug dosage,operation time,ICU stay time,hospital time,extubation time and 24-hour postoperative inotropic of each group were recorded.Results There were no difference in the age,sex,height,weight,cardiothoracic ratio,preoperative LVEF value,fluid intake and intake,intraoperative dosage of vasoactive drugs(nitroglycerin,dopamine,adrenaline,deoxyadrenaline),operation time,number of bypass roots,ICU stay time,hospital stay time,extubation time,drainage volume between the three groups(P>0.05).The 24 hour postoperative inotropic of the SI group was lower than that of the F group and the S group(P<0.05).There were no statistical difference in plasma cTnI and h-FABP concentrations between the F group and the S group at different time points(P>0.05).The plasma cTnI and h-FABP concentrations in the SI group

关 键 词：舒芬太尼 心肌缺血再灌注损伤 缺血后处理 心型脂肪酸结合蛋白 心肌肌钙蛋白 

分 类 号：R614[医药卫生—麻醉学]