丙泊酚后处理对非体外循环下冠脉搭桥手术患者的心肌保护作用  

Cardioprotective effect of propofol postconditioning on patients undergoing off⁃pump coronary artery bypass grafting

作　　者：邱忠志[1] 李萌[1] 陈广民 郭雷[1] QIU Zhong-zhi;LI Meng;CHEN Guang-min;GUO Lei(Department of Anesthesioloy,The First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院麻醉科,黑龙江哈尔滨150001

出　　处：《哈尔滨医科大学学报》2023年第3期299-302,共4页Journal of Harbin Medical University

摘　　要：目的探讨丙泊酚后处理对非体外循环下冠脉搭桥手术(off-pump coronary artery bypass grafting,OPCABG)患者的影响。方法选择本院2018年5月~2020年12月43例择期行OPCABG的患者,按麻醉方式分为七氟烷组(S组)和丙泊酚后处理组(P组)。麻醉维持期间,S组患者吸入1%~2%的七氟烷,P组患者在前降支再通后停止吸入七氟烷,恒速输注4~6 mg丙泊酚至术毕。于T1(入室)、T2(前降支再通后即刻)、T3(入ICU 24 h)时间点进行动脉血气分析,同时采集受试者动脉血5 mL。测定各组患者血浆中肿瘤坏死因子α(tumor necrosis factor-alpha,TNF-α)、白细胞介素1β(interleukin-1β,IL-1β)、白细胞介素6(interleukin-6,IL-6)、丙二醛(malondialdehyde,MDA)、超氧化物歧化酶(superoxide dismutase,SOD)、肌酸激酶同工酶(creatine kinase-MB,CK-MB)和心肌肌钙蛋白(cardiac troponin,cTnI)的水平。结果与S组比较,P组的IL-1β、IL-6、TNF-α、SOD和MDA浓度在T1、T3无统计学差异,在T2降低(P<0.05);CK-MB和cTnI浓度在T1、T2无统计学差异,在T3降低(P<0.05)。结论丙泊酚后处理可减轻OPCABG患者缺血-再灌注损伤引起的炎症反应和氧化应激,从而起到心肌保护的作用。Objective To evaluate the effect of postconditioning with propofol on patients un⁃dergoing off⁃pump coronary bypass grafting(OPCABG).Methods A total of 43 patients un⁃derwent OPCABG under general anesthesia from May 2018 to December 2020 in our hospital were selected and divided into sevoflurane group(group S)and propofol group(group P)ac⁃cording to type of anesthesia.Patients of group S were given full inhalation of 1%~2%sevoflurane,patients of group P were injected 4~6 mg propofol at constant speed immediately after anterior descending branch recanalization until the end of surgery.Arterial blood gas anal⁃ysis was performed at T1(entry into the room),T2(immediately after anterior descending branch recanalization)and T3(24 hours after admission to ICU),and 5 mL arterial blood were collected.Plasma levels of tumor necrosis factor⁃alpha(TNF⁃α),interleukin⁃1β(IL⁃1β),interleukin⁃6(IL⁃6),malondialdehyde(MDA),superoxide dismutase(SOD),creatine kinase⁃MB(CK⁃MB),cardiac troponin(cTnI)were detected in each group.Results Com⁃pared with group S,the concentrations of IL⁃1β,IL⁃6,TNF⁃α,SOD and MDA in group P showed no significant difference at T1 and T3,but decreased at T2.The concentrations of CK⁃MB and cTnI were not significantly different at T1 and T2,but decreased at T3(P<0.05).Conclusion Postconditioning with propofol can alleviate the inflammatory response and oxida⁃tive stress caused by ischemia⁃reperfusion injury in patients undergoing OPCABG,so as to pro⁃tect myocardium.

关 键 词：丙泊酚 非体外循环下冠脉搭桥手术 缺血-再灌注损伤 

分 类 号：R654.2[医药卫生—外科学]