七氟醚预处理对先天性心脏病患儿心内直视手术的心肌保护作用

目的：探讨七氟醚预处理对先天性心脏病（先心病）患儿围术期心肌缺血/再灌注损伤（ myocardial ischemia/reperfuison injury，MI/RI）的影响及其机制。方法择期拟行先心病手术患者40例，ASAⅠ或Ⅱ级，随机分为2组：对照组（ C组，n=20），不给予吸入性麻醉药；七氟醚预处理组（ S组，n=20），于劈开胸骨后持续吸入2MAC （2×1.71%）浓度的七氟醚，至体外循环（ cardiopulmonary bypass，CPB）开始前结束。2组均采用咪唑安定0.08~0.12mg/kg、芬太尼5~10μg/kg、维库溴铵0.1mg/kg行全身麻醉诱导，3min后气管内插管。术中按需追加咪唑安定、芬太尼及维库溴铵。分别记录主动脉阻断时间、体外循环时间、自动复跳及电除颤情况。于麻醉后切皮前（T0）、主动脉开放后10min（T1）、CPB停机即刻（T2）、CPB停机后6h（T3）和CPB停机后24h（T4）5个时间点抽取桡动脉血，检测血浆肌酸磷酸激酶同工酶（ creatine phosphokinase isoenzyme，CK-MB）、心肌肌钙蛋白I（ cardiac troponin I，cTnI）、丙二醛（ malondialdehyde，MDA）水平和超氧化物歧化酶（ superoXide dismutase，SOD）活性。结果2组CPB时间、主动脉阻断时间以及射血分数差异均无统计学意义（ p＞0.05）。2组cTnI、CK-MB、MDA水平均于T1时升高，T3时达到峰值，T4时出现下降。组内比较，在T1~4时cTnI、MDA水平均高于T0（p＜0.01）；各时点cTnI、MDA水平组间比较，T0时差异无统计学意义（p＞0.05），T1~4时S组cTnI、MDA水平低于C组（p＜0.01）。各时点CK-MB水平组间比较，T0~3时差异无统计学意义（p＞0.05），T4时S组CK-MB水平低于C组（p＜0.01）。C组SOD活性于T1时开始降低，T2时达最低值，T3时出现回升，T4时恢复T0水平；T1、T2及T3时SOD活性均低于T0（ p＜0.01），S组T1~4时SOD活性与T0比较差异无统计学意义（ p＞0.05）；各时点SOD活性组间比较，T0、T4时差异无统计学意义?

PERIOPERATIVE MYOCARDIAL PROTECTION OF SEVOFLURANE PRECONDITIONING IN CONGENITAL HEART DISEASE CHILDREN UNDERGOING OPEN-HEART SURGERY

OcjectiVe To interpret the perioperative myocardial protection of sevoflurane preconditioning during myocardial ischemia/reperfuison injury（ MI/RI）caused by open-heart surgery in congenital heart disease children. Methods Forty patients of scheduled for repair to ventricular septal defect（VSD）and to atrial septal defect（ASD）were randomly divided into two groups,control group （group C,n =20）and sevoflurane preconditioning group（group S,n =20）. In group S,2MAC of sevoflurane was continuously inhaled from the beginning of operation to the beginning of cardiopulmonary bypass（ CPB）,and no anesthetic used sevoflurane in group C. Patients of anesthesia were injected with intravenous midazolam（0. 08-0. 12mg/kg）,fentanyl（5-10μg/kg）and vecuronium（0. 1mg/kg）and＆amp;nbsp;anesthesia was maintained with midazolam,fentanyl and vecuronium in intermittent iv boluses was induced. The time of clamping aorta,cardiopulmonary bypass and operating,the rate of spontaneously rebeating of heart and the situation of electrocution defibrillation were recorded. The plasma levels of creatine phosphokinase isoenzyme（ CK-MB）,cardiac troponin I（ cTnI）,malondialdehyde（ MDA）and the activity of superoXide dismutase（SOD）were measured after induction of anesthesia（T0）,10minutes after aorta unclamping（T1）,immediately after CPB（T2）,6h（T3）and 24h（T4）after CPB. Results All patients were similar with regard to demographic data between two groups（p 〉0. 05）. cTnI,CK-MB, MDA in both group increased at T1 ,reached peak at T3 and declined at T4 . The cTnI,MDA level at T1-4 were higher than that at T0（ p 〈0 . 01 ）. There were no significant difference at T0 between two groups （p〉0. 05）,the cTnI,MDA level at T1-4 in group S was lower than that in group C（p〈0. 01）. The CK-MB level at T1-4 was higher than that at T0（ p 〈0. 01 ）. There was no significant difference at T0-3 between two groups（ p〉0. 05 ）,the CK-MB level at T4 in group S was lower than that i