异氟烷预适应对心内直视手术中缺血后心肌酶的影响

目的　观察体外循环下心内直视手术中心肌酶的变化 ,探讨异氟烷预适应对体外循环心脏手术中缺血后心肌的保护作用。方法　选择 36例先天性心脏病 (室缺或房缺 )患者 ,随机分为异氟烷预适应 (ISO)组和对照 (CON)组 ,每组各1 8例。分别于术前、主动脉开放后 30min、60min和 2 4h从锁骨下静脉抽取血样测定乳酸脱氢酶 (LDH)、肌酸激酶同功酶 (CK MB)和α 羟丁酸脱氢酶 (HBDH)。另外 ,在复跳期间记录室颤发生例数。结果　ISO组主动脉开放后出现室颤 7例 ,通过除颤复跳。CON组为 1 0例 ,其中 6例通过除颤复跳 ,两组差别无显著 (P >0 0 5)。主动脉开放 30min ,ISO组CK MB和HBDH均明显低于CON组 ;在开放 2 4h ,ISO组LDH、CK MB和HBDH均降低 (与CON组比较 :P <0 0 5)。结论　异氟烷预适应可以降低主动脉开放后心肌酶的水平 ,对体外循环下心内直视手术中缺血后心肌产生保护作用

Effects of isoflurane preconditioning on postischemia myocardial enzyme in the patients undergoing cardiac surgery

Objective To observe effects of isoflurane pr econditioning on postischemia myocardium in patients undergoing cardiac surgery. Methods 36 patients were divided randomly into two groups: isoflurane (ISO) group and control (CON) group (each group n=18). Maintenace of anesthesia with 2MAC isoflurane and fentanyl in the ISO group, and with fentanyl in the CON group. The venous blood samples were taken to measure the serum concentrations of myocardial enzymes. Results It was found that creatine kinase isoenzyme MB (CK-MB) and alpha hydrosybutyrate dehydrogenase (HBDH) in the ISO group were significantly lower than those in the CON group at after 30 min and 24 h reperfusion (P<0 05). Lactic dehydrogenase (LDH) significantly decreased in the ISO group at after 24 h reperfusion (P<0 05 vs CON group). Conclusion Isoflurane preconditioning has protective effects on myocardial stunning in patients undergoing cardiac surgery.