七氟烷后处理对体外循环下心脏瓣膜置换术患者心肌酶相关指标的影响

目的：：观察七氟烷后处理对体外循环下心脏瓣膜置换术患者心肌酶相关指标的影响。方法：选择体外循环下行心脏瓣膜置换术的风湿性心脏病患者72例,随机分为七氟烷后处理组( S组)和对照组( C组),每组36例。 S组采用主动脉开放时经体外循环机空氧混合器给予2.0%七氟烷,持续15 min,C组无以上处理,全凭静脉麻醉。分别于麻醉诱导前( T0)、主动脉开放后30 min( T1)、3 h( T2)、24 h( T3)采集颈内静脉血,离心10 min,上清液置于EP管于-20℃保存。检测患者血清心肌肌钙蛋白( cTnI)、肌酸激酶( CK)、肌酸激酶同工酶( CK-MB)、乳酸脱氢酶( LDH)浓度并对术中情况进行比较。结果：2组患者T1、T2和T3时间点血清cTnI、CK、CK-MB和LDH水平均较T0明显升高(P<0.01)。S组患者cTnI水平在T3时间点明显低于C组(P<0.01),CK在T2和T3时间点均低于C组(P<0.01和P<0.05),CK-MB在T1时间点显著低于C组(P<0.01), LDH 在T1、T2和T3时间均明显低于C组(P<0.01)；2组患者手术中的一般情况及术后使用多巴胺的总量等指标差异均无统计学意义(P>0.05)。结论：七氟烷后处理可以降低体外循环下心脏瓣膜置换术患者心肌酶的释放,减轻心肌缺血再灌注损伤,对心肌有一定的保护作用。

Effects of sevoflurane post-processing on the relative index of myocardial enzyme in patients treated with heart valve replacement under cardiopulmonary bypass

Objective:To observe the effects of sevoflurane post-processing on the relative index of myocardial enzyme in patients treated with heart valve replacement under cardiopulmonary bypass ( CPB ) . Methods:Seventy-two rheumatic heart disease patients treated with heart valve replacement under CPB were randomly divided into the sevoflurane post-processing group( group S) and control group(group C)(36 cases each group). The group S were treated with the 2% of sevoflurane by cardiopulmonary bypass into blood circulation for 15 minutes at the time of aorta opening,the group C were treated with intravenous anesthesia. The jugular venous blood was collected before anesthesia induction( T0 ) ,after 30 min( T1 ) ,3 h( T2 ) and 24 h( T3 ) of aorta opening,and centrifuged for 10 min, the supernatant of which was stored at -20℃. The serum levels of cardiac troponin( cTnI) ,creatine kinase( CK) ,creatine kinase( CK-MB) and lactate dehydrogenase( LDH) were meaured and compared at four time points. Results:Compared at T0 ,the levels of cTnI, CK,CK-MB and LDH in two groups significantly increased at T1,T2 and T3(P<0. 01). The levels of cTnI at T3,CK at T2 and T3,CK-MB at T1 and LDH at T1,T2 and T3 in group S were significantly lower than those in group C(P<0. 01 and P<0. 05). The differences of gerenal condition and total amount of dopamine using between two groups were not statistically significant(P>0. 05). Conclusions:Sevoflurane post-processing can reduce the myocardial enzyme releasing in patients treated with heart valve replacement under cardiopulmonary bypass,alleviate the injury of myocardial ischemia-reperfusion and protect the myocardum.