七氟醚后处理对心脏瓣膜置换术患者心肌酶的影响

目的:探讨体外循环下七氟醚后处理对心脏瓣膜置换术患者心肌酶的影响。方法:30例体外循环下行心脏瓣膜置换术患者,女19例,男11例,体重40~70 kg,年龄25~65岁,ASA分级Ⅱ~Ⅲ级,随机分为对照组(C组)与七氟醚后处理组(S组),每组15例。S组经体外循环于主动脉开放时以2%七氟醚灌入血液循环15 m in,C组不作以上处理,采用全凭静脉麻醉。分别于手术开始时(T1)、主动脉开放后0.5 h(T2)、主动脉开放后3 h(T3)、主动脉开放后24 h(T4)4个时点采集中心静脉血,提取上清置于EP管-20℃保存。检测血清乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白(cTnI)浓度,并记录两组患者血流动力学、体外循环时间、主动脉阻断时间、手术时间和术后使用多巴胺的总量。所有数据均作统计学分析。结果:两组患者围术期血流动力学指标均保持稳定。两组患者血清LDH、CK、CK-MB、cTnI水平均较术前显著升高(P<0.05);与C组相比,S组LDH在T4时明显降低(P<0.05),cTnI和CK在T3、T4时间点也明显降低(P<0.05),CK-MB在T2时点明显降低(P<0.05)。结论:体外循环七氟醚后处理可以降低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。     

七氟醚后处理对体外循环下心脏瓣膜置换术患者心肌氧化应激损伤的影响

目的 探讨七氟醚后处理对体外循环下心脏瓣膜置换术患者心肌氧化应激损伤的影响.方法 拟在体外循环下行心脏瓣膜置换术的风湿性心脏病患者30例,年龄30～59岁,体重42～62 kg,射血分数＞55%,ASA分级Ⅱ或Ⅲ级,NYHA心功能分级Ⅱ或Ⅲ级,采用随机数字表法,将患者随机分为对照组(C组)和七氟醚后处理组(S组),每组15例.S组于主动脉开放即刻经体外循环机给予2%七氟醚15 min,C组不做此项处理.于切皮前即刻(T1)、主动脉开放后30 min(T2)、3 h(T3)和24 h(T4)时取颈内静脉血样,检测血浆MDA浓度.于术前和停机后取左心耳组织,采用Western blot法测定α-谷胱甘肽-S-转移酶(α-GST)的表达.结果 与C组比较,S组T2,3时血浆MDA浓度降低,停机后心肌组织α-GST表达上调(P＜0.05).结论 七氟醚后处理可增强体外循环下心脏瓣膜置换术患者抗氧化能力,减轻心肌氧化应激损伤,该作用有助于减轻心肌再灌注损伤.

Abstract：

Objective To investigate the effect of sevoflurane postconditioning on the myocardial oxidative stress injury in patients undergoing heart valve replacement with cardiopulmonary bypass (CPB) . Methods Thirty ASA Ⅱ or Ⅲ and NYHA class Ⅱ or ID patients, aged 30-59 yr, weighing 42-62 kg, scheduled for cardiac valve replacement with CPB, were randomly divided into 2 groups ( n = 15 each) : control group (group C) and sevoflurane postconditioning group (group S) . Anesthesia was induced with iv injection of midazolam 0.05-0.08 mg/kg, fentanyl 3-6 μg/kg, vecuronium 0.10-0.15 mg/kg and etomidate 0.1-0.2 mg/kg. The patients were tracheal intu- bated and mechanically ventilated. Anesthesia was maintained with intermittent iv boluses of fentanyl and midazolam and continuous infusion of atracurium and propofol. In group S, 2% sevoflurane was given over 15 min via the cardiopulmonary bypass machine immediately after aortic unclamping. Blood samples from the internal jugular vein were collected immediately before skin incision (T1 ) and at 30 min, 3 h and 24 h after aortic unclamping (T2-4 ) for measurement of the plasma malondialdehyde level. Myocardial tissues were taken from the left auricle before operation and after termination of CPB for determination of α-glutathione-S-transferase expression by Western blot. Results The plasma malondialdehyde concentration was significantly lower at T2, 3, while a-glutathione-S-transferase expression in myocardial tissues higher after termination of CPB in group S than in group C ( P ＜ 0.05) . Conclusion Sevoflurane postconditioning can enhance the antioxidant capacity and attenuate the myocardial oxidative stress injury in patients undergoing cardiac valve replacement with CPB, which may be helpful to reduce myocardial ischemia-reperfusion injury.