地氟醚预处理对心肌损伤与修复的影响  

Effects of Desflurane Pretreatment on Myocardial Injury and Repair

作　　者：杨跃武[1] 杭燕南[1] 孙大金[1] 

机构地区：[1]上海第二医科大学仁济医院麻醉科,上海200001

出　　处：《上海第二医科大学学报》2003年第4期337-339,347,共4页Acta Universitatis Medicinalis Secondae Shanghai

摘　　要：目的观察血中转移生长因子β1(TGFβ1)、肌酸激酶 (CK)和肌酸激酶 -同工酶 (CK -MB)的浓度在地氟醚预处理心肺转流 (CPB)前后的变化。　方法选择瓣膜置换术病人 2 0例 ,随机分为地氟醚组和芬太尼组 ,直接动脉测压连续监测血流动力学变化 ;比色法测血中CK、CK -MB的浓度 ;ELISA测血浆中TGFβ1的变化。　结果二组病人的血流动力学变化过程基本一致 ;CK、CK -MB浓度于CPB后 10min即显著升高 (P <0 .0 1) ,CPB后 6 0min进一步上升(P <0 .0 1) ,但两个时间点的组间比较均无显著差异。TGFβ1的变化过程与此不同 ,CPB后地氟醚组的TGFβ1值显著降低 (P <0 .0 1) ,再灌注 6 0min时进一步下降 (P <0 .0 1) ,芬太尼组的TGFβ1于CPB后两个时间点均变化不明显。结论地氟醚预处理对心肌损伤的影响与芬太尼相似 ;鉴于TGFβ1主要参与受损组织的修复过程 。Objective To observe the changes of transforming growth factor β 1 (TGFβ 1), creatine kinase (CK), creatine kinase-MB (CK-MB) induced by desflurane pretreatment pre- and post cardio-pulmonary bypass (CPB). Methods Twenty patients undergoing cardiac valve replacement were divided randomly into two groups, fentanyl group and desflurane group. Hemodynamics was monitored through arterial cannula. Central venous blood samples were collected for measurements of CK, CK-MB and TGFβ 1. CK,CK-MB were measured by colorimetry and TGFβ 1 was measured by ELISA. Results The changes of hemodynamics were consistent in two groups; CK,CK-MB increased 10min after reperfusion (compared with pre-CPB: P <0.01) and further increased at 60min (compared with 10min reperfusion: P <0.01). But there was no significant difference between both groups. The changes of TGFβ 1 were different to the two indices, the concentrations of TGFβ 1 decreased significantly (compared with pre-CPB: P <0.01) at 10min after reperfusion in the desflurane group, and further decreased at 60 min after reperfusion (compared with 10 min reperfusion: P <0.01); TGFβ 1 showed no difference between 10min and 60min after reperfusion in the fentanyl group. Conclusion Desflurane pretreatment has similar effects to myocardial reperfusion injury as fetanyl; but desflurane may not benefit myocardial repair as it decreases TGFβ 1.

关 键 词：地氟醚 缺血预处理 瓣膜置换术 血流动力学 转移生长因子Β1 肌酸激酶 肌酸激酶-同工酶 

分 类 号：R614[医药卫生—麻醉学]