丙泊酚与七氟醚对体外循环期间肠道屏障功能影响的比较

目的：比较心脏手术CPB期间丙泊酚和七氟醚对肠道屏障功能的影响。方法：选择需CPB的心脏手术90例，随机分为非CPB对照组C、丙泊酚组P组和七氟醚组S组n=30。三组病例麻醉诱导均采用咪唑安定、芬太尼、依托咪酯、罗库澳铵快速气管插管。麻醉维持C与P组用丙泊酚靶控输注，辅助芬太尼和罗库溴铵。S组用七氟醚吸入，辅助芬太尼和罗库溴铵。P和S组病人分别在麻醉前T1、CPB前T2、CPB30分钟时T2、CPB停机后30分钟T4采取中心静脉血、C组在麻醉前T1、手术开始后15minT2、手术开始后40minT3、手术结束时T4采集中心静脉血检测血浆内毒素浓度。结果：麻醉前三组血浆内毒素浓度均在正常范围，无统计学差异在T3、T4时P组和S组血浆内毒素浓度明显高于C组（P〈0.01）、S组高于P组（P〈0.01），T2时S组高于P组和C组（P〈0.05）.结论：CPB期间异丙酚对肠道屏障功能的保护作用优于七氟醚.

The Effects of Propofol Compared with Sevenflurane on Intestinal Mucosal Barrier during CPB in Cardiac Surgery

Objectives： To study the effects of propofol compared with sevenflurane on intestinal mucosal barrier during CPB in cardiac surgery. Methods： Ninety patients were divided into three groups, control group （C without CPB）, propfol group （P） and sevenflurane group （S）. Anesthesia of all patients was induced with midazolam, fentanyl, etomidal and rocuronium. Anesthesia was maintained with propofol TCI in group C and group P with sevenflurane in group S. The blood samples of group P and S were taken from CVP line before anesthesia （T1）, before CPB （T2）, 30 min after CPB （T3） and 30min after end ofCPB （T4）. The blood samples of group C were taken from CVP line before anesthesia （T4）, 15min after operation （T2）, 40min after operation （T3） and the end of operation （T4）. The blood samples were collected for determination of endotoxin concentration. Results： The endotoxin concentration of the three groups before anesthesia （T1） is negative. The endotoxin concentration of P and S group were higher than C group at the time point of T3, T4 （P〈0.01）, S group was higher than P group at the time point ofT3, T4 （P〈0.01）, S group was higher than C and P group at the time point of T2 （P〈0.05）. Conclusion： The effect of propofol on intestinal mucous barrier is better than sevenflurane during CPB.