异氟醚间断预处理对非停跳冠状动脉移植患者的心肌保护作用  

Prior interrupted isoflurane administration provides the protection of myocardial in patients undergoing off-pump coronary artery bypass surgery

作　　者：张亮[1] 王成彬[1] 林多茂[1] 马骏[1] ZHANG Liang;WANG Chengbin;LIN Duomao;MA Jun(Department of Anesthesiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所麻醉科

出　　处：《心肺血管病杂志》2019年第12期1257-1260,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:在非停跳冠状动脉移植术(OPCABG)患者中,比较异氟醚间断预处理与丙泊酚持续静脉麻醉,对患者血流动力学及cTnI和CK-MB的影响情况。方法:本研究为随机-对照前瞻性临床研究。入组患者随机分为持续丙泊酚麻醉组(P组,n=30)和间断异氟醚预处理静吸复合组(Iso组,n=30)。P组中,术中持续静脉输注丙泊酚3~5 mg·kg^-1·h^-1维持麻醉深度。Iso组中,于切皮前5 min,间断吸入洗出1MAC异氟醚2次循环。术中常规时刻点记录血流动力学指标(平均动脉压、中心静脉压、体循环阻力和心率等)。在术前和术后留取患者血样监测心肌损伤指标(cTnI和CK-MB)。结果:所有入组患者均成功完成手术,术后未发生严重的不良反应;丙泊酚组和异氟醚间断吸入预处理组患者的基本资料以及各指标、参数的基线值均不存在明显的统计学差异(P>0.05);两组患者基础cTnI和CK-MB比较,差异无统计学意义(P>0.05)。结果提示,两组患者的cTnI和CK-MB在术后都明显升高,峰值出现在术后4 h。在术后4 h,Iso组患者血样中的cTnI和CK-MB值明显低于P组(P<0.05)。结论:在OPCABG术中使用异氟醚间断预处理降低了cTnI和CK-MB的表达,减轻了患者的心肌损伤。Objective:The aim of this study was to compare the effects of isoflurane preconditioning on Hemodynamic index,cTnI and CK-MB levels with propofol in patients undergoing off-pump coronary artery by-pass surgery(OPCABG).Methods:We performed a single-center,randomized,prospective,controlled clini-cal study.Patients were randomly assigned to receive either propofol(n=30),or interrupted isoflurane(n=30).In group P,propofol administration was continued at 3-5 mg·kg^-1·h^-1 intravenous injection for the du-ration of surgery.Five minutes prior to incision,patients of the isoflurane group(group Iso)received 2 cycles of 1 MAC isoflurane.Global hemodynamic variables(MAP,CVP,SVR,CI,and heart rate)were measured at regular time points.Blood samples for measurement of cTnI and CK-MB were withdrawn before the start of sur-gery and postoperatively.Results:All the patients enrolled successly complete the surgery,and there was no serious side effects.There was no statistical difference between the two groups in basic information and baseline characteristics(P>0.05).The two groups had similar baseline preoperative serum cTnI and CK-MB values.cTnI and CK-MB values were higher in both groups in the periods after surgery and peaked at the 4th hour after surgery in both groups.At 4 h after surgery,the cTnI and CK-MB values in the patients in the Iso group were lower compared to the P group(P<0.05).Conclusions:Our findings provide some insight that prior interrupt-ed isoflurane administration could regulate cTnI and CK-MB and result ed in actual attenuation of myocardial in-jury in patients undergoing OPCABG surgery.

关 键 词：异氟醚 心肌保护 非停跳冠状动脉移植手术 

分 类 号：R54[医药卫生—心血管疾病]