摘要
目的 研究地氟烷预适应对心内直视手术中缺血 /再灌注对心肌损伤的保护作用及可能机制。方法 择期行先天性心脏病矫正术的患者 4 0例 ,随机分为地氟烷预适应组(A组 ,n =2 0 )和对照组 (B组 ,n =2 0 )。两组患者均采用相同剂量芬太尼麻醉 (30 μg/kg) ,其中A组在主动脉阻断前吸入 10min 1MAC的地氟烷 ,随后继以 5min的洗脱期 ;而B组只给予 15min的纯氧吸入。观察麻醉前 (T0 ) ,主动脉开放后即刻 (T1)、2h(T2 )、6h(T3 )、2 4h(T4)、4 8h(T5)、各时点的血浆肌酸激酶同工酶 (CK MB) ,心肌肌钙蛋白I(cTnI)水平以及主动脉开放后心脏自主复跳率。结果 A组在主动脉开放后血浆CK MB(T2 、T3 )及cTnI(T1～T5)浓度与B组相比有显著降低 (P <0 0 5 ) ,并且心脏自主复跳率有显著增高。结论 在临床心内直视手术中 ,由缺血 /再灌注造成的损伤 ,地氟烷预适应可以产生和缺血预适应相似的心肌保护作用。
Objective To evaluate the myocardial protection of desflurane preconditioning against ischemia-reperfusion injury and investigate its probable mechanism .Methods Forty patients needing open heart surgery with cardiopulmonary by-pass(CPB)were divided randomly into two groups: desflurane preconditioning group (group A) and control group (group B).The patients of both group A and group B were anesthetized with high dose fentanyl(30 μg/kg).The patients of group A underwent 10 min of 1 minimal alveolar concentration(MAC) of deflurane followed by 5 min washout before aorta clamping,but group B was only given 15 min 100% O 2 before aorta clamping.The central venous blood samples were collected for measurement of CK-MB and myocardiac troponin I(cTnI) before anesthesia(T 0) and immediately(T 1),2 h(T 2),6 h(T 3),24 h(T 4),48 h(T 5) after aorta opening.The rate of spontaneous heart rebeat was observed after aorta opening.Results After reperfusion, the concentration of CK-MB(T 2,T 3)and cTnI (T 1～T 5) in group A was significantly lower than that in group B; meanwhile, the rate of spontaneous heart rebeat in group A was higher than that in group B. Conclusion These results indicate that pre-ischemic administration of deflurane dose cause anaesthetic-induced preconditioning that protects myocardium against ischemia-reperfusion injury.
出处
《安徽医科大学学报》
CAS
2004年第5期391-393,共3页
Acta Universitatis Medicinalis Anhui
