七氟烷吸入麻醉对婴幼儿心脏手术围术期心肌损伤标志物的影响

目的研究全程吸入七氟烷麻醉对婴幼儿心脏手术围术期血流动力学及血浆肌钙蛋白I(cTnI)、肌酸激酶(CK)及其同工酶(CKMB)的影响,探讨七氟烷全程吸入麻醉方法在婴幼儿心脏手术应用的可行性及其对心肌保护的效应。方法择期行心脏手术的婴幼儿先天性心脏病患者60例,随机分为七氟烷吸入麻醉组(S组,n=30)及静脉麻醉组(V组,n=30),分别在术中实施七氟烷或氯胺酮-芬太尼麻醉,以脑电双频指数判定麻醉深度。观察术中的血流动力学变化,分别于围术期多时点采取中心静脉血,测定血清cTnI、CK、CKMB的水平。记录两组转机时间、主动脉阻断时间、开放至复跳时间、自动复跳或电击复跳情况以及术后拔除气管导管时间和在ICU滞留时间。结果两组平均动脉压、心率在诱导后、切皮、停机及术毕无显著差异(P0.05),两组cTnI在体外循环开始后均不同程度升高,S组升高值较V组低,在CPB后各时点的差异显著(P0.01)。CK、CKMB明显高于转流前,S组的变化值均较V组小(P0.01)。两组心脏自动复跳率、窦性心率恢复率、电除颤率、心律失常发生率无显著差异(P0.05),两组术后拔除气管导管时间和在ICU滞留时间差异显著(P0.05)。结论全程吸入七氟烷麻醉应用于婴幼儿心脏手术是可行的,同时在婴幼儿心脏手术围术期,可以降低血浆cTnI、CK及CKMB水平,对患儿心肌起到保护作用。

The influence of sevoflurane inhalation anesthesia on the hemodynamics and myocardial injury markers in perioperation of infant heart surgery

Objective To investigate the influence of total sevoflurane inhaling on hemodynamics and plasma concentration of cardiac troponin Ⅰ （cTnⅠ）,creatine phosphokinase （CK）,and creatine phosphokinase isoenyme （CKMB） in infant heart surgery,and to explore the myocardial protective effect of sevoflurane.Methods Sixty infants undergoing selective cardiac surgery were recruited.Patients were randomly assigned to sevoflurane group （Group S,n =30） and intravenous anesthesia proup （Group V,n =30）,and received sevoflurane inhalation or ketamine injection for anesthetic induction and maintenance respectively,by bispectral index （BIS） to determine the depth of anesthesia.Intraoperative hemodynamics changes of patients were observed.The central venous blood samples were taken at various times during perioperation to measure the serum levels of cTnⅠ,CK and CKMB.In two groups,cardiopulmonary bypass （CBP）time,aortic cross-clamping time,heart rebeating situations,extubation time,ICU stay time were recorded.Results In two groups,mean artery pressure and heart rate were not significantly different at post-induction,skin incision,CBP termination and at the end of the surgery （P ＞0.05）.After CPB plasma concentration of cTnⅠ increased in two groups,but the increase values in group S were lower than that in group V （P ＜0.01）.CK,CKMB apparently increased.The changes of CK,CKMB in group S were significantly lower than that in group V （P ＜0.01）.The rate of heart spontaneous re-beating,sinus rhythm recovery,defibrillation and arrhythmia were not significantly different between two groups （P ＞0.05）.Extubation time and ICU stay time in group S were shorter than those in group V （P ＜0.05）.Conclusion The inhalation of seven halothane anesthesia in infants undergoing cardiac operation is feasible.This method can decrease the serum levels of cTnⅠ,CK and CKMB of infant patients in perioperation,and shows myocardial protective effects.