非体外循环冠状动脉旁路移植术的麻醉与心肌保护--丙泊酚与异氟烷的比较

目的　比较丙泊酚与异氟烷在行非体外循环冠状动脉旁路移植术 (CABG)时 ,对心肌损伤的保护作用。方法　 2 6例患者分为丙泊酚组和异氟烷组。分别于麻醉前、术中和术后测定血浆肌钙蛋白I(cTnI)、磷酸肌酸激酶同工酶 (CK MB)、白介素 6 (IL 6 )和乳酸浓度。结果　两组血浆cTnI于术后 4h显著升高 ,但组间差异无统计学意义 ;丙泊酚组IL 6值在术中、术后 4h低于异氟烷组 ;丙泊酚组术中和术后 4h乳酸值也有所降低。结论　丙泊酚或异氟烷用于非体外循环CABG手术时 ,在减轻心肌损伤程度方面作用相似 ,而在抑制心肌炎性反应和改善心肌代谢方面 ,丙泊酚优于异氟烷。

ANESTHESIA AND MYOCARDIAL PROTECTION DURING CORONARY BYPASS SURGERY WITHOUT CARDIOPULMONARY BYPASS: COMPARISON BETWEEN PROPOFOL AND FENTANYL

Objective To evaluate the possible protective effect of isoflurane and propofol on myocardium during off pump coronary artery bypass grafting (CABG) surgery. Methods Twenty-six patients undergoing elective CABG without cardiopulmonary bypass were allocated into propofol group (n=13) and isoflurane group (n=13). Anesthesia was performed in propofol group with propofol plus fentanyl, while isoflurane and fentanyl were used in isoflurane group. Artery blood samples were collected before induction of anesthesia, and during and after the surgery. Plasma troponin I (cTnI), creatine kinase-MB (CK-MB), interleukin-6 (IL-6), and lactate concentrations were determined respectively. Results At the 4 hours after operation, plasma level of cTnI was significantly increased in both groups, and no significant differences were found between them. Compared with baseline values, IL-6 in propofol group showed no significant changes at each endpoint. However, IL-6 values in isoflurane group were significantly higher than those in propofol group during and after surgery (P<0.05). In addition, lactate levels in propofol group showed statistically significant reduction, but not in isoflurane group. Conclusions Both propofol and isoflurane have similar effect on preventing perioperative myocardial injury during CABG without cardiopulmonary bypass, as shown by changes in levels of cTnI and CK-MB. However, propofol is better in reducing myocardial inflammatory response as well as in improving myocardial metabolism perioperatively.