七氟醚预处理对心脏瓣膜置换术患者心肌酶的影响

目的 观察体外循环下七氟醚预处理对心脏瓣膜置换术患者心肌酶的影响.方法 择期全麻下行心脏瓣膜置换患者40例,美国麻醉医师协会(ASA)分级Ⅰ～Ⅲ级,随机分为七氟醚预处理组(S组)和对照组(C组),每组20例.S组于手术开始后持续吸入1.0MAC七氟醚,至体外循环开姑时结束；C组不用任何吸入性麻醉药.分别于麻醉前(T0),主动脉阻断即刻(T1),主动脉开放后0.5 h(T2)和1 h(T3),术后8 h(T4)和24 h(T5)采集桡动脉血,检测血浆心肌肌钙蛋白1(cTnl)的浓度、肌酸磷酸激酶(CK)和肌酸磷酸激酶同工酶(CK-MB)的活性.结果 两组患者麻醉前cTnl水平、CK和CK-MB活性均在正常范围,在主动脉开放后各时间点明显升高(P＜0.05)；S组血清中cTnl水平、CK和CK-MB活性在各时间点均明显低于C组.结论 七氟醚预处理对心肌缺血/再灌注损伤有一定保护作用.

Effects of sevoflurane pretreatment on myocardial enzyme for patients with cardiac valve replacement surgery

Objective To explore the effect of sevoflurane pretreament on cardiac enzyme in the patients during value replacement surgery under cardiopulmonary bypass(CPB).Methods 40 ASAⅠ-Ⅲ patients under cardiopulmonary bypass for cardiac valve replacement,were allocated randomly into 2 groups(n=20):sevoflurane pre-inhalation group(group S),ischemia reperfusion group(group C).In group S,1.0 MAC sevoflurane was continuously inhaled from the beginning of operation to the beginning of CPB,and no anesthetic was inhaled in group C.Blood samples were collected and plasma levels of cTnI,CK and CK-MB were measured before anesthesia(T0),immediate after aorta clamping(T1),at 30 min(T2) and 24 h(T3) after aorta cross-clamping,8 h(T4) and 24 h(T5) after operation,respectively.Results Plasma levels of cTnI,CK and CK-MB were within normal range before operation and there was no difference between the two groups.At each timepoints after reperfussion,compared with T0,levels of cTnI,CK and CK-MB in the two groups were increased significantly(P<0.05).Compared with the group C,the content of cTnI,CK and CK-MB MB were significantly lower in the group S.Conclusion Preconditioning with sevoflurane inpatients undergoing cardiac valve replacement has a protective effect on myocardial ischemia reperfusion.