重症心脏瓣膜置换术的麻醉与心肌保护分析

目的分析注射用磷酸肌酸钠(PC)对于置换术的麻醉与心肌保护的效果。方法选取2010年1月至2012年1月收治的重症心脏瓣膜病患者48例,随机分为观察组、对照组。两组患者均采用芬太尼、咪唑安定加肌松药以及持续泵入丙泊酚麻醉。但剂量及具体注射方法不同,观察组:应用小剂量芬太尼、咪唑安定加肌松药静注,异氟醚间断吸入麻醉。对照组:采用芬太尼、肌松药静注,异氟醚间断吸入麻醉。观察组患者在此基础上予以静脉滴注PC用于心肌保护。比较两组患者血浆肿瘤坏死性因子(TNF-α)、白细胞介素(IL)-6、IL-8水平及血清心肌肌钙蛋自I(cTnI)、肌酸激酶同工酶(CK-MB)、肌酸激酶(CK)浓度,综合以上检测指标判断PC药物的治疗疗效。结果观察组的IL-6水平和IL-8水平在升主动脉开放1 h后以及6 h后均明显高于观察组。两组在诱导时和切皮时血压及心率存在显著性的差异。两组患者在术后各个时段血清cTnI、CK-MB、CK浓度有明显差异。两组比较差异具有统计学意义(P<0.05)。结论 PC降低重症心脏瓣膜置换患者的血浆TNF-α、IL-8、IL-6水平的效果明显,从而有效降低手术中炎症的产生,对机体的心、肝、肺、肾等重要脏器具有一定的保护作用。

The anesthesia of severe heart valve replacement surgery and the analysis of myocardial protection.

Objective Analysis of the injection of sodium phosphate muscle （PC） for the anesthesia of replacement and the effect of myo- cardial protection. Methods 48 cases from January 2010 to January 2012 our hospital with severe heart valve disease were included into this stud- y. These patients were randomly divided into observation group and control group. Patients of two groups were treated with fentanyl, midazolam and muscle relaxants and intermittent inhalation of isoflurane anesthesia for treatment. However, the dose and injection method were different. The in- travenous injection of sodium phosphate muscle （PC） was used for myocardial protection. The plasma TNF - alpha, IL - 6, IL - 8 levels of the two groups were used to determine the injection of sodium phosphate muscle （ PC ） drug treatment efficacy. Results In the ascending aorta, IL - 6 level and IL - 8 level at lh and 6h after opening in the observation group were significantly higher than those of the observation group. There was significant difference in the induction and skin incision, blood pressure and heart rate of the two groups. There was significant difference in the ser- um cTnI, CK - MB, CK levels at various times of the two groups. Conclusion PC can reduce plasma TNF - a, IL - 8, the effect of IL - 6 levels in severe heart valve replacement patients, can reduce effectively inflammation in the surgery. The heart, liver, lung, kidney and other vital organs of the body can be protected.