舒芬太尼与芬太尼对非体外循环下冠状动脉旁路移植术PMN功能及血流动力学影响的对比研究

目的:对比研究舒芬太尼与芬太尼在非体外循环下冠状动脉旁路移植术(OPCAB)不同时间点,外周血中性粒细胞(PMN)核因子κB(NF-κB)活性成分p65蛋白含量及血流动力学的变化。方法:选择2005年3月至2006年6月OPCAB患者40例,年龄42~72岁,麻醉诱导后,经右颈内静脉置入双腔中心静脉管,常规放置Swan-Ganz导管,分别于麻醉前、麻醉诱导后、吻合血管后、术毕、术后24h和48h抽取肘静脉血20mL,分别用于检测NF-κB亚单位p65信使核糖核酸(mRNA)表达[逆转录-聚合酶链反应(RT-PCR)方法]及p65蛋白含量(western blotting方法)。记录2组患者正性肌力药用量,同时连续监测各时间点心率(HR)、平均动脉压(MAP)、平均肺动脉压(MPAP)、中心静脉压(CVP)、肺毛细血管锲压(PCWP),心脏指数(CI)、左心室作功指数(LVSWI)、右心室作功指数(RVSWI)、鼻温、脑电双频谱指数(BIS),分别计算和比较2组患者各项心脏功能指标。结果:S组较F组使用正性肌力药少(P<0.01);PMNp65mRNA及p65蛋白在F组术后各检测点均较术前升高,而S组仅术后24h与术前相比有升高(P<0.05),2组间术后各对应时间点比较,p65mRNA和p65蛋白F组均较S组升高明显,差异有显著性(P<0.01,P<0.05);术后心脏功能部分指标S组明显优于F组(P<0.05,P<0.01)。结论:舒芬太尼组对机体PMNNF-κB激活程度明显低于芬太尼组,术后炎性反应程度轻,对心脏功能恢复有益。

Comparative study on the hemodynamics and p65 protein of neutrophils between group sufentanil and fentanyl during OPCAB

Objective:To compare the hemodynamics and expressions of subunit of nuclear factor-(B(NF-κB)-p65 protein in human polymorphoneclear neutrophils(PMN)between group sufentanil and group fentanyl during off-pump coronary artery bypass grafting(OPCAB).Method:fourty patients scheduled for OPCAB were devided into group sufentanil and group fentanyl with twenty patients in each group.PMN were isolated from fresh whole blood of all patients at the following time points:before induction of anesthesia(T1),after induction of anesthesia(T2),after revascularization(T3),the end of operation(T4),24 h after operation(T5),48 h after operation(T6),PMN were incubated in media containing buffer for 3 h.A specific antibody against the p65 subunit of NF-κB was used and the content of p65 protein was detected by RT-PCR and Western blotting.and the variables of hemodynamics were measured either at every time points.Result:There was no difference between two groups before surgery.At T3,T4,T5,the content of p65 was significantly increased(P<0.05 or P<0.01)in group fentanyl as compared with group sufentanil,the content of p65 was inreased only at T5 as compared with the baseline in group sufentanyl.The cardiac index(CI)in group sufentanil were significantly increased(P<0.05 or P<0.01)as compared with T1 after operation,while it was mildly decresed in group fentanyl.The systemic vascular resistance indexes were significantly decreased in group sufentanil as compared with group fentanyl at T4 and T5(P<0.05),The heart rates in these two groups were significantly elevated intraoperatively(P<0.05).the number of patients who received positive inotropic drugs was less in group sufentanil than in group fentanyl(P<0.05).Conclusion:Compared with group fentanyl,sufetanil can benefit the patients in the hemodynamic conditions and inflammatory reaction.