丙泊酚、咪达唑仑对小儿紫绀型先天性心脏病体外循环心内直视术的心肌保护作用

目的 比较观察丙泊酚和咪达唑仑对紫绀型先天性心脏病患儿心内直视术的心肌保护作用。方法选择ASAI～Ⅱ级心内直视手术的紫绀型先天性心脏病患儿32例,随机等分为两组,每组16例,丙泊酚复合小剂量芬太尼组（PF组）,咪达唑仑复合小剂量芬太尼组（MF组）。观察患儿血流动力学变化,脉搏血氧饱和度及体温,记录术后拔管时间及术后ICU停留时间;取主动脉阻断后10～20min（T2）和主动脉开放后10-20min（L）时的心肌组织,观察心肌血红素加氧酶．1（HO．1）的表达;采集开放静脉通路时（T0）、主动脉开放后2h（T4）、术后24h（L）的静脉血,检测血浆中肌钙蛋白I（eTnI）含量。结果PF组患儿术后的平均拔管时间和平均ICU停留时间较MF组短（分别为14．17h vs 23．65h,30．17h vs 49．47h）;两组患儿T4时（PF：97ng/ml±33ng／ml,MF：138ng／ml±56ng／m1）cTnI的水平均高于T0（PF：0．17ng／ml±0．10ng／ml,MF：0．62ng／ml±0．96ng／m1）和T5（PF：23ng／ml±13ng／ml,MF：24ng／ml±6ng／m1）,L时cTnI的水平高于T0,但两组间同时点值比较差异无统计学意义;PF和MF组T2时心肌HO-1表达均低于T,（灰度值PF：182．2±0．8vs125．6±2．1,MF：193．5±1．4VS145．5±7．4）,MF组患儿T2、T3时心肌HO-1的表达低于PF组同时点值。结论丙泊酚和咪达唑仑对紫绀型先天性心脏病患儿体外循环心内直视术心肌有保护作用,丙泊酚在刺激心肌保护性蛋白HO-1方面优于咪达唑仑。

Cardioprotective effects of propofol and midazolam in children with congenital heart diseases undergoing open heart surgery

OBJECTIVE: To observe the cardioprotective effects of propofol and midazolam in children with congenital heart diseases undergoing open heart surgery. METHODS: Thirty-two children with cyanotic congenital heart diseases of ASA classes I - II were randomly divided into 2 equal groups: propofol combined with low dose fentanyl group (Group PF) and midazolam combined with low dose fentanyl group (Group MF). The changes of hemodynaics, ECG, SpO2, nasopharyngeal and rectal temperatures were monitored continuously. The time of tracheal extubation and ICU staying time were recorded. Venous blood samples were collected when the venous channel was opened (T(0)), 2 h after declamping of the aorta (T(4)), and 24 h after operation (T(5)) to detect the plasma cardiac troponin I (cTnI). Myocardium samples were collected 10 - 20 min after aorta cross-clamp (T(2)), and 10 - 20 min after declamping of the aorta (T(3)) to undergo immunohistochemistry to observe the expression of heme oxygenase-1 (HO-1). RESULTS: The tracheal time of Group GF was 14.17 h, significantly shorter than that of Group MF (23.65 h, P < 0.05), and the ICU staying time of Group GF was 30.17 h, significantly shorter than that of Group MF (49.47 h, P < 0.05). The plasma cTnI level at T(4) of Group GF was 97 ng/ml +/- 33 ng/ml, significantly higher than those at T(0) (0.17 ng/ml +/- 0.10 ng/ml, P < 0.01) and T(5) (23 ng/ml +/- 13 ng/ml, P < 0.01). The plasma cTnI level at T(4) of Group MF was138 ng/ml +/- 56 ng/ml, significantly higher than those at T(0) (0.62 ng/ml +/- 0.96 ng/ml, P < 0.01) and T(5) (24 ng/ml +/- 6 ng/ml, P < 0.01). And the plasma cTnI levels at T(5) of these 2 groups were both significantly higher than those at T(0) (both P < 0.01), however, there was no significant difference in the plasma cTnI level at any time point between these 2 groups. The grey values of HO-1 in cardiac muscle cells at T(2) of Groups GF and MF were 182.2 +/- 0.8 and 193.5 +/- 1.4, both significantly higher than those at T(3) (125.6 +/- 2.1 and 145.5 +/- 7.4 respectively, both P < 0.01), and the grey values of HO-1 in cardiac muscle cells at T(2) and T(3) of Group MF were both significantly higher than those of Group GF (both P < 0.05). CONCLUSION: Both propofol and midazolam have protective effects for the children with congenital heart diseases undergoing open heart surgery, and propofol is superior to midazolam in the cardioprotection.