右美托咪定对心肺转流下冠状动脉旁路移植术后心脏同步化运动的影响

目的 探讨右美托咪定对心肺转流(CPB)下行冠状动脉旁路移植术(CABG)患者心脏同步化运动的影响.方法 择期CPB下行CABG患者24例,年龄43～75岁,体表面积1.53～2.00m2,ASAⅡ或Ⅲ级,心功能Ⅱ或Ⅲ级.采用随机数字表法分为两组:右美托咪定组(D组)和对照组(C组),每组12例.两组术中麻醉维持均采用全凭静脉麻醉,D组于主动脉开放后经微量注射泵静注右美托咪定负荷剂量0.5μg/kg(10 min内注射完),然后以0.5 μg·kg-1·h-1维持给药至术毕,C组静注等量生理盐水.分别于开胸前(T1)和CPB停机后30 min(T2)、60 min(T3)记录血流动力学指标:HR、MAP、CVP、心脏指数(CI),左右心室收缩功能指标:左室射血分数(LVEF)、右室射血分数(RVEF)和心脏同步性参数:PR间期、QRS时限、室间机械延迟(IVMD).结果 与T1时比较,T2、T3时两组HR明显增快、CI明显升高(P＜0.01);与C组比较,D组T2、T3时PR间期明显延长(P＜0.05).两组间QRS时限及IVMD差异无统计学意义.结论 CPB下冠状动脉旁路移植术患者,右美托咪定负荷剂量0.5μg/kg后以0.5μg· kg-1·h-1维持能够延长PR间期,影响房室间同步化运动,但对左右心室间电机械同步化运动无明显影响.     

Early extubation does not increase complication rates after coronary artery bypass graft surgery with cardiopulmonary bypass

Background: With the evolution of anesthesia and surgical procedures, fast track extubation has gained an increased interest, mainly based on the possibility of reducing health costs seemingly without compromising patient care. Aim: To compare two groups of patients submitted to a non-fast track extubation and a fast track extubation protocol after coronary artery bypass graft surgery with cardiopulmonary bypass, regarding their times of ventilation and intubation and their complication rates in the postoperative period. Methods: During the year of 1998, 323 sequential patients scheduled for isolated coronary artery bypass graft surgery with cardiopulmonary bypass were enrolled in the study. Fifty-nine patients were excluded due to preoperative use of emergent mechanical and/or inotropic hemodynamic support, low body mass index (≤18–20 kg/m²), reoperations for acute surgical complications, off-pump coronary artery bypass graft surgery, severe respiratory disease, recent myocardial infarction (≤7 days) and absence of relevant data. Previous myocardial infarction (≥7 days), prophylactic intraaortic balloon pump and use of postoperative vasoactive drugs were not exclusion criteria. We compared 76 patients sequentially submitted to anesthesia by one of the authors with a fast track extubation protocol and 188 patients sequentially submitted to anesthesia by others in the same period and using a conventional anesthetic protocol. Results: Demographic data, previous medical and cardiac history, preoperative medication and operative data were all similar between the two groups. The mean ventilation and intubation times were significantly shorter in the fast track extubation group than in the non-fast track extubation patients (30 min vs. 7 h and 50 min vs. 8 h, respectively). Forty-two percent of patients in the fast track extubation group were extubated on arrival at the intensive care unit. Morbidity and mortality were similar in both groups. Conclusions: The study shows that a very fast track extubation protocol may be safely implemented in patients submitted to coronary artery bypass graft surgery with cardiopulmonary bypass.     

异丙酚对体外循环下冠状动脉搭桥术病人的脑保护作用

目的观察异丙酚对体外循环(CPB)下冠状动脉搭桥术(CABG)病人的脑保护作用。方法择期CPB下行CABG病人40例,年龄50～65岁,ASAⅡ或Ⅲ级,随机分为2组(n=20)：异丙酚组(P组)和芬太尼组(F组)。两组常规麻醉诱导,麻醉诱导后即刻P组持续静脉输注异丙酚4～6 mg·kg~(-1)·h~(-1),F组持续静脉输注芬太尼0．7～10μg·kg~(-1)·h~(-1)。P组术中间断静脉注射芬太尼,F组间断静脉注射咪唑安定,两组术中均间断静脉注射维库溴铵及吸入异氟烷维持麻醉。桡动脉、右颈内静脉穿刺球部置管,用于监测平均动脉压、中心静脉压和采集血液标本。分别于麻醉诱导后30 min(T_1)、CPB开始5 min(T_2)、降温结束后5 min(T_3)、复温结束后5 min(T_4)、CPB结束(T_5)采集颈内静脉球部血,进行血气分析。分别于,T_1、T_2、T_5、术后4 h(T_6)、24 h(T_7)、48 h(T_8)、72 h(T_9)采集颈内静脉球部血,测定血浆S-100B浓度。术后10 d内进行精神状态量表(MMSE)评分,MMSE评分1～24分为有精神神经系统并发症(POMD)组,MMSE评分大于24分为对照组(C组)。结果P组、F组血浆S-100B浓度在T_(6,8)时高于,T_1,T_7时P组血浆S-100B浓度低于F组(P＜0．05)；术后P组POMD发生率(2／20)低于F组(6／20)(P＜0．01),但是两组脑损伤症状均于术后10 d恢复正常；与T_1比较,P组与F组SjvO_2在T_3时升高,T_4时下降(P＜0．05),T_4时P组颈静脉血氧饱和度(SjvO_2)高于F组(P＜0．05)；与T_1比较,POMD组、C组SjvO_2在T_3时升高,T_4时下降(P＜0．05),T_4时C组SjvO_2高于POMD组(P＜0．05)。结论异丙酚可减轻CPB下CABG病人脑损伤。     

Sevoflurane anesthesia did not affect postoperative cognitive dysfunction in patients undergoing coronary artery bypass graft surgery

Purpose The purpose of this study was to retrospectively examine whether sevoflurane anesthesia had any ameliorative effects on postoperative cognitive dysfunction in patients undergoing coronary artery bypass graft (CABG) surgery. Methods One hundred and nine patients underwent elective CABG surgery at our institution from May 1999 to May 2001. From May 1999 to August 2000, the main anesthetic regime used included a propofol infusion with no volatile anesthetic being administered during the surgery. From September 2000 to May 2001, the main anesthetic regime used was 1.5%–2.0% sevoflurane from the postinduction period until the end of the surgery. All patients underwent a battery of neurological and neuropsychological tests 1 day before and 6 months after the operation. Results The use of sevoflurane did not have any significant effects on the postoperative levels of cognitive dysfunction. In contrast, multiple logistic analysis showed that age [odds ratio (OR), 1.3; P = 0.047], diabetes mellitus (OR, 2.5; P = 0.03), and atherosclerosis of the ascending aorta (OR, 1.4; P = 0.047) appeared to be predictive factors of postoperative cognitive dysfunction. Conclusion This retrospective study showed no relationship between postoperative cognitive dysfunction and the use of sevoflurane.     

Factors affecting postoperative morbidity and mortality in isolated coronary artery bypass graft surgery

Purpose  This study was conducted to investigate predictors of mortality before and after isolated coronary artery bypass grafting (CABG). Methods  Single-institutional data on risk factors and mortality were collected for 8890 patients who underwent isolated CABG by the same group of surgeons. The relationship between risk factors and outcome was assessed using univariate and multivariate analyses in two risk models: a preoperative model (model 1) and then a pre-, intra-, and postoperative model (model 2). Results  The mean age of the patients (25.4% women and 74.6% men) was 58.5 ± 9.7 years. Fifty-five (0.6%) patients died after surgery. Hypercholesterolemia was the most common comorbidity factor (61.1%), followed by hypertension, a smoking habit, recent myocardial infarction (MI) <21 days, and diabetes. Postoperative tamponade, graft occlusion, and MI (0.01%) were the least common complications. The patients spent 39.7 ± 33.9 h in the intensive care unit (ICU) postoperatively. Patients were followed up for a minimum of 30 days. The multivariate analysis of our preoperative risk model revealed that the best predictors of operative mortality were a history of diabetes, hypertension, previous CABG, the presence of angina, arrhythmia, Canadian Cardiovascular Society Classification (CCS) of grade III or IV, ejection fraction (EF) ≤30%, three-vessel disease, and left main disease. Conclusion  After surgery, and with the inclusion of all the pre-, intra-, and postoperative variables into model two, the following were revealed to be prognostic factors for in-hospital mortality: a history of diabetes, hypertension, the presence of angina, CCS grades III or IV, EF −30%, absence of internal mammary artery (IMA) use, prolonged cardiopulmonary bypass (CPB) time, and prolonged ICU stay.     

体外循环与非体外循环冠状动脉搭桥术后心电图胸前导联R波振幅变化的差异

目的 探讨体外循环与非体外循环冠状动脉搭桥术后心电图胸前导联R波振幅变化的临床意义。方法 监测38例非体外循环冠状动脉搭桥术后不同时点心电图胸前导联V4、V5的R波振幅的变化，同时测定不同时点的心肌细胞损伤的生物标记物肌酸磷酸激酶同功酶（CK-MB）和肌钙蛋白I（cTnI），并与同时期38例体外循环冠状动脉搭桥术病人进行比较。结果 非体外循环冠状动脉搭桥术后即刻、6、18和24h心电图胸前导联R波电位幅度无明显变化，CK-MB和cTnI也无明显变化，而体外循环冠状动脉搭桥术后相同时间点心电图胸前导联R波振幅明显减小（P〈0．01），CK-MB和cTnI明显增加（P〈0．01）。结论 非体外循环冠状动脉搭桥术比体外循环冠状动脉搭桥术对心肌损伤明显减小。     

右美托咪定对老年患者冠状动脉旁路移植术后认知功能的影响

目的 观察右美托咪定对老年患者冠状动脉旁路移植术(coronary artery bypass graft,CABG)后认知功能的影响. 方法 择期行CABG的老年患者60例,年龄60岁～70岁,美国麻醉医师协会(ASA)分级Ⅱ或Ⅲ级,采用随机数字表法分为两组,右美托咪定组(D组)和生理盐水对照组(C组),每组30例.D组患者于麻醉诱导前静脉注射右美托咪定0.6 μg/kg(15 min),随后以0.2 μg· kg-1·h.速率输注至术毕;C组给予等容量生理盐水;其余麻醉措施两组相同.于麻醉后手术前(T1)、心肺转流(cardiopulmonary bypass,CPB)开始后30 min(T2)、CPB结束后30 min(T3)、术后6(T4)、24 h(T5)测定颈内静脉球部血清肿瘤坏死因子(tumor necrosis factor,TNF)-α、白细胞介素(interlukin,IL)-6水平及S100β蛋白浓度.分别于术前1d及术后第1、4、7天对患者进行简易精神状态量表(mini-mental state examination,MMSE)测验. 结果 T2～T5时,D组血清TNF-α、IL-6水平及S100β蛋白浓度明显低于C组(P＜0.05).与T1比较,T2～T5两组血清TNF-α、IL-6水平及S100β蛋白浓度均明显升高(P＜0.05).D组患者MMSE评分术后第4天[(25.2±1.4)分]、第7天[(26.6±13)分]明显低于术前1 d[(29.3±0.8)分],C组患者MMSE评分术后第4天[(23.2±1.0)分]、第7天[(25.6±1.3)分]也较术前1 d[(29.4±1.0)分]明显降低(P＜0.05).术后第4、7天,术后认知功能障碍(postoperative cognitive dysfunction,POCD)的发生率D组(36.7％、30％)均明显低于C组(46.7％、36.7％)(P＜0.05).结论 右美托咪定可降低CPB下行CABG的老年患者POCD的发生率,其机制可能与抑制炎性反应以及S100β蛋白表达有关.     

Endogenous stem cells in patients undergoing coronary artery bypass graft surgery

Considerable research efforts have recently been made towards the application of autologous stem cell therapy for cardiovascular regeneration. Patients with coronary artery disease undergoing surgery represent a potential target. As yet, this approach has failed to obtain satisfactory evidence in clinical studies. However, several observational studies have described mobilising effect of cardiac surgery on endogenous stem cells, although the mechanisms of this phenomenon and its clinical relevance are not defined. This article reviews available clinical data on the effect of cardiac surgery on endogenous stem cells and outlines some of the controversies in this area.     

Effects of mild hypothermic cardiopulmonary bypass on blood viscoelasticity in coronary artery bypass grafting patients

The purpose of this study was to determine the changes in blood viscoelasticity during and after coronary artery bypass grafting (CABG) and to identify correlations between blood viscoelasticity and patients' age, duration of cardiopulmonary bypass (CPB), and cross-clamp time. After Institutional Review Board approvals, patients (n = 10) who were subjected to mild hypothermic CPB were included in this study. Viscosity and elasticity were measured at strains of 0.2, 1, and 5 using a Vilastic-3 Viscoelasticity Analyzer. Arterial blood samples were collected pre-CPB, on normothermic CPB, hypothermic CPB, after rewarming, and after CPB. Viscosity and elasticity at strains of 0.2 and 1 were altered significantly during and after CPB compared to the pre-CPB (p < 0.01). In particular, elasticity of blood was diminished during normothermic bypass and could not be recovered after CPB (p < 0.01). Although there were strong correlations between blood viscoelasticity, duration of CPB, and cross-clamp time on normothermic CPB, only the patients' age showed a positive correlation between viscosity (r = 0.61, p = 0.05), and elasticity (r = 0.89, p < 0.001) after CPB. These results suggest that mild hypothermic CPB alters the blood viscoelasticity during and after CABG.     

Normothermic cardiopulmonary bypass and cardioplegia reduce inotropic requirements and creatine kinase-MB after coronary artery bypass graft surgery

Purpose To determine whether normothermic cardiopulmonary bypass (CPB) and cardioplegia preserve myocardial function, reduce inotropic requirements, and reduce markers of myocardial ischemia following coronary artery bypass graft surgery (CABG). Methods We retrospectively reviewed the charts of 171 consecutive patients undergoing elective CABG by a single surgeon from April 1994 to December 1995. Hypothermic CPB with intermittent cold cardioplegia was used in 83 patients and normothermic CPB with intermittent warm cardioplegia in 88 patients. Demographic, surgical, hemodynamic, and inotropic requirements and laboratory data were reviewed. Results The duration of CPB was significantly shorter in the normothermic group (113±27vs 90±21 min;P<0.0001). After CPB the cardiac index was similar between groups, but significantly larger doses of both dopamine and dobutamine were required (8vs 5μg·kg⁻¹·min⁻¹,P<0.0001), and significantly more patients required norepinephrine administration in the hypothermic group (18%vs 6%;P=0.01). Postoperative peak values of creatine kinase MB fraction (CK-MB) were significantly lower in the normothermic group (80±60vs 55±54 IU·I⁻¹;P<0.0001). Conclusion Normothermic CPB and cardioplegia reduce inotropic requirements and CK-MB following CABG.     

老年病人冠脉搭桥术中脑氧代谢与术后精神障碍的关系

目的 观察老年病人体外循环(CPB)冠脉搭桥术(CABG)中脑氧代谢变化与术后精神障碍的关系。方法 年龄≥65岁择期CABG病人30例,取右颈内静脉和桡动脉血进行血气分析,葡萄糖及乳酸测定,并计算脑血流量/脑氧耗比值(CBF/CMRO_2)、脑氧耗/脑糖耗比值(CMRO_2/CMRglu)及乳酸生成量(ADVL);术后用ICU精神错乱评估量表(CAM-ICU)将病人分为精神障碍(POMD)组和无精神障碍(NPMD)组,比较两组术中指标差异。结果 (1)术后7例病人发生POMD,发生率为23.33％;(2)复温期8例病人颈内静脉血氧发生去饱和(颈内静脉血氧饱和度≤50％或颈内静脉血氧分压≤25mmHg),其中POMD组3例(发生率43％),NPMD组5例(发生率22％),两组差异显著(P<0.01);(3)复温期POMD组CBF/CMRO_2显著低于NPMD组(P<0.01);(4)降温期、复温期和停CPB,尤其是复温期,POMD组CMRO_2/CMRglc明显低于NPMD组,P<0.01,而ADVL明显高于后者(P<0.01)。结论老年病人CABG术后精神障碍与CPB期间脑氧代谢失衡有关。     

Lumbar versus thoracic epidural buprenorphine for postoperative analgesia following coronary artery bypass graft surgery

BACKGROUND: Thoracic epidural analgesia (TEA) is reported to provide effective analgesia following cardiac surgery. We compared the effect of buprenorphine (BN) through the lumbar and thoracic epidural routes for postoperative analgesia following coronary artery bypass graft surgery (CABG). METHODS: Forty patients with normal left ventricular ejection fraction scheduled for CABG were randomly divided into two groups, the TEA group (n = 19) and the lumbar epidural analgesia (LEA) group (n = 20). For postoperative pain relief they received epidural BN 0.15 mg at the first demand for pain relief following extubation. A top-up dose of BN 0.15 mg was administered in cases where visual analogue scale (VAS) score was > 3 at 1 h after first dose. Subsequent breakthrough pain was treated with 30 mg intramuscular ketorolac tromethamine (ketorolac). Pain assessed by VAS score on a 0-10 scale, respiratory rate, FEV1, FVC, mean arterial blood pressure, cardiac index, PaO2 and PaCO2 were measured at frequent intervals. Side effects of epidural opioids were noted. RESULTS: Both groups were comparable in demographic characteristics, had similar VAS scores from 1 to 24 h postoperatively, required similar amounts of intramuscular ketorolac for break-through pain and had comparable pulmonary functions and side effects. CONCLUSION: This study shows that BN by the lumbar epidural route for analgesia after CABG compares favourably with the same drug through the thoracic route in terms of quality of analgesia and incidence of side effects.     

Predictors of inotropic support during weaning from cardiopulmonary bypass in coronary artery bypass grafting surgery

Early or prophylactic inotropic drug administration is occasionally required to facilitate separation from cardiopulmonary bypass (CPB) in cardiac surgery. However, it is not without untoward effects and should be conducted on the basis of rational criteria. The purpose of our study was to clarify variables associated with the requirement for inotropic support during separation from CPB and to testify whether pre-CPB left ventricular (LV) function, as evaluated by transesophageal echocardiography (TEE), is one of the significant variables. Clinical profile data and TEE findings were retrospectively analyzed for 91 patients who had received elective primary isolated coronary artery bypass grafting (CABG) surgery. Post-CPB inotropic drug administration initiated prior to aortic decannulation was considered inotropic support for terminating CPB. Stepwise multiple logistic regression analysis identified pre-CPB LV regional wall motion abnormalities (RWMA), NYHA class, age, and duration of CPB (in order of significance) as factors associated with inotropic support for discontinuing CPB. Pre-CPB LV enddiastolic area or fractional area change was not a significant variable in the multivariate model. Our result suggests that evaluation of pre-CPB LV RWMA is useful in predicting the need of inotropic intervention during separation from CPB in patients undergoing CABG surgery. This study was performed at The Weiler Hospital of The Albert Einstein College of Medicine, and was presented in part at the 17th annual meeting of The Society of Cardiovascular Anesthesiologists, Philadelphia, Pennsylvania, May 8–10, 1995     

Endoscopic sphincterotomy for cholangitis after recent coronary artery bypass graft surgery

It is particularly attractive to perform endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy for cholangitis due to common bile duct stone because of the increased morbidity and mortality of the alternative therapy of choledochal exploration. The safety of therapeutic ERCP after recent myocardial injury is unknown since there are only five previously reported cases. Three patients underwent therapeutic ERCP after recent coronary artery bypass graft surgery for indication of recent cholangitis due to choledochal stones. Initially, the cholangitis was managed medically in all patients. Endoscopic sphincterotomy (ES) was performed 11, 17, and 14 days after coronary artery bypass graft surgery. The calculi were successfully extracted by sweeping the choledochus with a balloon-tipped catheter or basket in all cases. During ERCP the vital signs remained stable; no cardiac arrhythmias, hemorrhage, or pulmonary complications occurred. Our study demonstrates that therapeutic ERCP is not absolutely contraindicated after recent myocardial injury and suggests that ES is preferable to surgery for cholangitis due to common bile duct stones.     

瑞芬太尼预处理对冠状动脉旁路移植术患者体外循环期间的脑保护作用

目的 探讨瑞芬太尼预处理对冠状动脉旁路移植术患者体外循环期间的脑保护作用.方法 择期行体外循环(CPB)冠状动脉旁路移植术的患者40例,ASA Ⅱ或Ⅲ级,随机分为4组(n=10):对照组(C组)和不同剂量瑞芬太尼预处理组(R_(1～3)组).R_(1～3)组于麻醉诱导后30 min时分别静脉输注瑞芬太尼0.6、1.2和1.8 μg·kg~(-1)min~(-1),输注时间5 min,重复3次,间隔5 min;C组以生理盐水代替瑞芬太尼.于麻醉诱导前(T_0)、CPB开始前(T_1)、CPB 30 min(T_2)、CPB结束(T_3)时取颈内静脉血样3 ml,采用ELISA法测定血浆S-100β蛋白浓度,采用比色法测定血浆超氧化物歧化酶(SOD)活性和丙二醛(MDA)浓度.结果 与T_0时比较,T_(1～3)时各组血浆S-100β蛋白和MDA浓度升高,SOD活性降低(P<0.05或0.01);与C组比较,R_3组T_(2,3)时血浆S-100β蛋折和MDA浓度降低,SOD活性升高(P<0.05),R_1组和R_2组上述指标差异无统计学意义(P>0.05).结论 瑞芬太尼(1.8μg·kg~(-1)min~(-1))预处理可减轻冠状动脉旁路移植术患者CPB诱发脑损伤,其机制可能与抑制脑脂质过氧化反应有关.     

Increased risk associated with combined carotid endarterectomy and coronary artery bypass graft surgery: a propensity-matched comparison with isolated coronary artery bypass graft surgery

OBJECTIVE: Risk associated with combined carotid endarterectomy and coronary artery bypass graft surgery (CEA/CABG) is controversial. The present study objective was to compare morbidity and mortality outcomes in well-matched patients who underwent combined CEA/CABG surgery with patients undergoing isolated CABG surgery with and without a history of a prior CEA. DESIGN: This investigation was designed as a retrospective case-controlled study using data from the Cardiothoracic Anesthesia Patient Registry in a single tertiary institution. The patient population consisted of 1,698 isolated CABG surgery patients with carotid artery stenosis >40%, 708 patients who underwent an isolated CABG surgery but had a history of a prior CEA, and 272 combined CEA/CABG surgery patients who underwent surgery from January 4, 1993, through June 30, 2003. Propensity modeling techniques were used to calculate a propensity score for each patient. Greedy matching resulted in 272 propensity-matched pairs of combined CEA/CABG and isolated CABG patients (primary analysis) and 241 propensity-matched pairs of combined CEA/CABG surgery and isolated CABG surgery with previous CEA patients (secondary analysis). A Fisher exact, chi-square, Wilcoxon rank sum, and Student t test were applied appropriately to compare the propensity-matched pairs. RESULTS: The distribution of covariates among the propensity-matched combined CEA/CABG and isolated CABG groups were similar. Among the propensity-matched pairs in the primary analysis, overall morbidity and mortality were higher in the combined CEA/CABG group compared with the CABG group alone (overall morbidity 15% v 8.8%, p = 0.025, and mortality 5.2% v 1.1%, p = 0.007, respectively). Median intensive care unit (ICU) length of stay was longer (47 v 31 hours, p = 0.004) and hospital length of stay was longer (12 v 9 days, p < 0.001) for the combined CEA/CABG surgery compared with isolated CABG surgery, respectively. Postoperative cardiac, neurologic, serious infection, and renal morbid events were similar between the 2 groups. In the secondary analysis, the rates of mortality, overall morbidity, and neurologic morbidity were similar between the groups, whereas the median ICU and hospital length of stay were significantly longer in the combined CEA/CABG group (47.6 v 39.8 hours, p = 0.025, and 12.0 v 9.0 days, p < 0.001, respectively). CONCLUSIONS: Increased mortality and overall morbidity outcomes were found in the combined CEA/CABG group when compared with well-matched isolated CABG patients, but similar when compared with well-matched isolated CABG patients with a history of previous CEA. Patients undergoing combined CEA/CABG procedures had significantly longer ICU and hospital lengths of stay compared with patients undergoing isolated CABG procedures.     

体外循环旁路洗入七氟醚对冠状动脉旁路移植术患者心肌损伤的影响

目的 评价体外循环(CPB)旁路洗入七氟醚对冠状动脉旁路移植术(CABG)患者心肌损伤的影响.方法 择期CPB下行CABG的患者40例,年龄50 ～ 64岁,体重53～90 kg,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将患者随机分为2组(n=20):对照组(C组)和七氟醚组(S组).S组于CPB开始即刻通过体外循环机洗入1.0％ ～2.0％七氟醚,持续到CPB结束,C组不给予七氟醚.于麻醉诱导后5 min(T0)、术后6 h(T1)、12 h(T2)及24 h(T3)时采集血样,测定血浆心肌肌钙蛋白I(cTnI)浓度和磷酸肌酸激酶同工酶(CK-MB)活性.于主动脉阻断前和CPB结束时取右心耳组织,电镜下观察心肌超微结构,并行心肌细胞线粒体损伤评分.结果 与C组比较,S组T2和T3时血浆cTnI浓度,CPB结束时心肌细胞线粒体损伤评分降低(P＜0.05),血浆CK-MB活性差异无统计学意义(P＞0.05).S组心肌病理学损伤较C组减轻.结论 CPB旁路洗入七氟醚可减轻CABG术患者的心肌损伤.     

体外循环下冠脉搭桥术患者术前口服尼可地尔的脑保护作用

目的 评价术前口服尼可地尔对体外循环(CPB)下冠脉搭桥术(CABG)患者的脑保护作 用。方法 择期CPB下CABG患者30例,ASAⅡ或Ⅲ级,随机分为2组,尼可地尔组(N组)和对照组 (C组),每组15例。N组麻醉前30min口服尼可地尔10 mg,C组麻醉前不给予尼可地尔。术前24 h (术前)、术后24 h行神经功能(MMSE)评分;并于麻醉诱导前(T1)、CPB后30 min(T2)、术后6 h(T3)、术 后24 h(T4)抽取静脉血,ELISA法测定血清神经特异性烯醇化酶(NSE)和S100β蛋白(S100β)浓度。结 果 两组术后24 h MMSE评分均较术前降低,术前、术后24 h MMSE评分差值N组高于C组。T2,3时 两组血清NSE浓度均高于T1,N组T2,3NSE浓度升高幅度低于C组。C组T2-4血清S100β浓度高于 T1,N组T4高于T1(P<0．05)。N组T2,3血清S100β浓度升高幅度低于C组(P<0．05或0．01)。结论 术前口服尼可地尔对CPB下CABG患者术后脑功能有一定的保护作用。