摘要
目的 观察瑞芬太尼预处理对先天性心脏病患儿体外循环诱导心肌缺血再灌注损伤的影响。方法 先天性心脏病室间隔缺损患儿60例，年龄2-14岁，ASA分级Ⅰ级或Ⅱ级，心功能分级Ⅰ级或Ⅱ级，随机分为4组（n=15），对照组（C组）持续静脉输注瑞芬太尼0．2-0.5μg·kg^-1·min^-1;R1组、R2组、R3组主动脉阻断前分别以1、2、4μg·kg^-1·min^-1的速率静脉输注瑞芬太尼5 min，间隔5 min后重复输注瑞芬太尼，每组重复3次。于麻醉诱导前（T1）、主动脉阻断前即刻（T2）、主动脉开放即刻（T3）、主动脉开放后2 h（T4）、24 h（T5）、48 h（T6）采取血标本，检测心肌肌钙蛋白Ⅰ（cTnⅠ）的浓度和磷酸肌酸激酶同工酶（CK-MB）的活性。记录主动脉阻断前各时点的HR和MAP及主动脉开放后心脏复跳情况。结果 与C组比较，R1组、R2组和R3组在主动脉阻断前各时点HR及MAP差异无统计学意义，R1组、R2组和R3组在T1、T2时cTnⅠ及CK-MB差异无统计学意义（P〉0．05），R3组在T3时cTnⅠ降低，R2组、R3组在T3时CK-MB降低，R1组、R2组和R3组在T4、T5、T6时cTnⅠ及CK-MB降低（P〈0．05或0．01）;与R1组比较，R3组在T4时cTnⅠ降低（P〈0．05）。结论 瑞芬太尼预处理可减轻先天性心脏病患儿体外循环诱导的心肌缺血再灌注损伤。
Objective To investigate the protective effect of remifentanil preconditioning on myocardium against ischemia-reperfusion injury （I/R） induced by cardiopulmonary bypass （CPB） in pediatric patients with congenital heart disease. Methods Sixty children with ventricular septal defect （ASA grade Ⅰ or Ⅱ , NYHA class ⅠorⅡ ） aged 2-14 yr were randomly divided into 4 groups （n = 15 each）： control group （C） and three remifentanil preconditioning groups （R1, R2, R3 ）. Ketamine 5 mg/kg was given i.m. before induction of anesthesia. Anesthesia was induced with midazolam 0.1 mg/kg , etomidate 0.3 mg/kg and remifentanil 1 μg/kg . Tracheal intubation was facilitated with vecurenium 0.1 mg/kg . Control group received continuous remifentanil infusion at 0.2-0.5 μg·kg·^-1 · min^- 1 , while in the 3 remifentanil groups （ R1 , R2, R3 ） the patients received 3 episodes of 5 min remifentanil infusion at 1/2/4 μg·kg·^-1 · min^- 1 at 5 min interval before aortic clamping. Venous blood samples were obtained before induction of anesthesia （ T1 , baseline）, immediately before aortic clamping （%）, immediately （T3） and at 2 h （%） ,24 h （T5） and 48 h （T6 ） after aortic unclamping for determination of plasma cTnⅠ concentration and CK-MB activity. The recovery of spontaneous heart beat was also recorded. Results The plasma cTnⅠ concentration and CK-MB activity were significantly lower after aortic unclamping at T4, T5 , T6 in group R1 , R2 and R3 than in control group. The plasma concentration of cTnⅠ were significantly lower at T4 in group R3 than in group R1 . There was no significant difference in MAP and HR before aortic clamping and recovery of spontaneous heart beat after aortic unclamping among the 4 groups. Conclusion Remifentanil preconditioning can protect myocardium against CPB-induced I/R in children with congenital heart disease.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2007年第5期431-434,共4页
Chinese Journal of Anesthesiology
基金
安徽省教育厅自然科学基金资助项目（2003kj228）
关键词
哌啶类
缺血预处理
心肌再灌注损伤
心肺转流术
儿童
Piperidines
Ischemic preconditioning
Mycocardial reperfusion injury
Cardiopulmonary bypass
Child
