异丙酚与安氟醚或七氟醚静吸复合麻醉对心肌酶的影响

目的:观察异丙酚与安氟醚或七氟醚静吸复合麻醉对心肌酶的影响.方法:32例择期非心脏手术的全麻病人,随机分为4组(每组8例),分别给予安氟醚麻醉(A组)、七氟醚麻醉(B组)、异丙酚-安氟醚麻醉(C组)、异丙酚-七氟醚麻醉(D组).其中A、B组为对照组,C、D组为观察组.分别于麻醉前、麻醉诱导后2 h和术后3 d采集静脉血测血清磷酸肌酸激酶(CK)及其同功酶(CK-MB)、天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(HBDH).结果:麻醉诱导后2 h,A组CK、CK-MB值、LDH及HBDH值升高,与麻醉前比较差异有显著性(P<0.01或P<0.05);B组CK和CK-MB值升高,与麻醉前比较差异有显著性(P<0.05或P<0.01).术后3 d,A、B两组CK值升高,与麻醉前和麻醉诱导后2 h比较差异有显著性(P<0.01或P<0.05),AST值升高,与麻醉前比较差异有显著性(P<0.01或P<0.05).而且A、B两组相比较,A组的CK、LDH值升高幅度明显大于B组(P<0.05).C、D两组仅CK值在术后3 d与麻醉前比较差异均有显著性(P<0.01),但其升高幅度均明显低于A、B两组的同时值(P<0.01),其余各项心肌酶的变化在麻醉诱导后2 h及术后3 d差异均无显著性(P>0.05).与C组比较,A组在麻醉诱导后2 h CK、CK-MB、HBDH值升高(P<0.01),LDH值升高(P<0.05);在术后3 d CK值升高(P<0.01).与D组比较,B组CK值在麻醉诱导后2 h及术后3 d升高(P<0.01),CK-MB值在麻醉诱导后2 h升高(P<0.05).结论:安氟醚和七氟醚两者均能使心肌酶升高,但安氟醚所致的心肌酶升高幅度更明显;临床麻醉剂量的异丙酚能有效地防止安氟醚和七氟醚麻醉时心肌酶的升高.

Effect of propofol-enflurane or propofol-sevoflurane combining anaesthesia on myocardial enzymes

Objective : To investigate the effect of propofol enflurane or propofol sevoflurane combinng anaesthesia on myocardial enzymes in sera of patients. Methods: Thirty two adult patients receiving non cardiac surgery under general anaesthesia were divided into Group A,( n =8),group B ( n =8),group C ( n =8) and group D ( n =8) given enflurane,sevoflurane or propofold enflurant or propofol sevoflurane,respectively. Group A and group B were control and group C and D were observed. The serum specimens were taken from all patients before anesthesia 2 h after anesthesia induction and 3 d after operation, respectively,to measure enzymatic activities of CK,CK MB,AST LDH and HBDH.Results:Activities of enzyme CK, CK MB,AST,LDH and HBDH from sera of patients in group A and CK and CK MB in group B were increased more signifcantly 2 h after anesthesia induction than those before anesthesia ( P <0 01 or P <0 05) . The enzymatic activities of CK in both group A and B were increased more significantly 3 d after operation than those before anesthesia 2 h after induction ( P <0 01 or P <0 05) and AST activity in both gropu A and B 3 d after operation was increased more significantly than that of before aneshensia only ( P <0 01 or P <0 05). Furthermore, activity of CK and LDH in group A was remarkably increased in comparison with group B ( P <0 05) . The enzymatic activitie of CK in group C and D were higher 3 d after operation than that before anesthesia only,but lower than those in both group A and B at the same time points ( P <0 01). In comparision with group C, the activities of CK,CK MB,HBDH and LDH 2 h after induction and CK only 3 d after operation in group A were higher than those before anesthesion ( P <0 01 or P <0 05). Activity of CK 2 h after induction and 3 d after operation or CK MB 2 h after induction in group B were higher than those in group D. Conclusion: Both enflurane especially sevoflurane can increase activities of myocardial enzymes in sera of patients,and increase of the myocardial enzymes resulted from enflurane or sevoflurane can be effectively prevented by propofol in clinical dosage.