七氟醚预处理联合后处理对体外循环下瓣膜置换术患者cTnⅠ、Mb、CK-MB及MDA的影响

目的：评价七氟醚预处理联合后处理对体外循环下瓣膜置换术患者血清肌钙蛋白Ⅰ、肌红蛋白、肌酸激酶同工酶及丙二醛的影响。方法拟行心脏瓣膜置换术的风湿性心脏病患者50例，年龄37～60岁，体重44～70 kg，美国麻醉医师协会分级Ⅱ～Ⅲ级，美国纽约心脏病学会心功能分级Ⅱ～Ⅲ级，采用随机数表法将患者分为2组（n ＝25）：对照组（C 组）和七氟醚预处理联合后处理组（S 组）。S 组在体外循环开始前吸入1．5倍最低肺泡有效浓度七氟醚10 min，并在升主开放后即刻通过体外循环机输注1．5 MAC 七氟醚10 min；C 组不适用任何吸入麻醉药。两组分别在麻醉诱导前、升主动脉开放后15 min、8 h、24 h（T1－4）经中心静脉采集血样，检测血肌钙蛋白Ⅰ、肌红蛋白、肌酸激酸同工酯及丙二醛表达。记录两组患者心脏自动复跳例数、再灌注心律失常评分情况。结果两组患者在 T2－4血清血肌钙蛋白、肌红蛋白、肌酸激酸同工酯及丙二醛均高于 T1；与 C 组比较，S 组血肌钙蛋白、肌红蛋白、肌酸激酸同工酯及丙二醛在 T2－4表达下调，再灌注心律失常评分降低，自动复跳率升高（P ＜0．05）。结论七氟醚预处理联合后处理可以降低体外循环下心脏瓣膜置换术患者血肌钙蛋白、肌红蛋白、肌酸激酸同工酯水平，产生明显心肌保护作用，其机制可能与减轻患者心肌细胞氧化应激有关。

The effect of sevoflurane preconditioning combined with postconditioning on serum concentration of cTn I,Mb,CK-MB and MDA in patients undergoing cardiac valve replacement with cardiopulmonary bypass

Objective To investigate the effect of sevoflurane preconditioning combined with postconditioning on serum concentration of cTnⅠ,Mb,CK -MB and MDA in patients undergoing cardiac valve replacement with cardiopulmonary by-pass.Methods Fifty ASA physical status Ⅱor Ⅲ patients(NYHA Ⅱor Ⅲ),aged 37 ~60 years,weighing 44 ~70 kg,with rheumatic heart disease undergoing cardiac valve replacement under CPB,were enrolled and divided randomly into sevoflu-rane preconditioning combined with postconditioning group(group S)and control group(group C).In group S,1.5 MAC sevoflurane was inhaled for 10 min via the anesthesia machine before the start of CPB,and infused for 10 min via the extra-corporeal circulation machines starting from the time point immediately after aortic unclamping.Before anesthesia induction, 15 min,8 h,and 24 h after aortic unelamping(T1 -4 ),blood samples were collected from the central vein for determination of the levels of cTnⅠ,Mb,CK -MB and MDA in plasma.The restoration of spontaneous heart beat,reperfusion arrhythmia scores were recorded.Results Compared with T1 ,the concentration of cTnⅠ,Mb,CK -MB and MDA were increased at T2 ~T4 in both group(P <0.05).Compared with group C,the concentration of cTnⅠ,Mb,CK -MB and MDA were de-creased at T2 ~T4 ,the rate of restoration of spontaneous heat beat was increased,reperfusion arrhythmia scores were de-creased in group S(P <0.05).Conclusion Sevoflurane preconditioning combined with postconditioning can remarkably decrease the concentration of cTnⅠ,Mb,CK -MB and MDA,and provide myocardial protection in patients with rheumatoid heart disease during valve replacement surgery with CPB,probablely by reducing myocardial oxidative stress injury.