摘要
目的：评价一氧化氮（NO）在舒芬太尼后处理减轻体外循环（CPB）下心脏瓣膜置换术患者心肌缺血再灌注损伤中的作用。方法：择期行心脏瓣膜置换术患者60例，年龄19～64岁，ASAⅡ～Ⅲ级，心功能Ⅱ～Ⅲ级。随机分为对照组（c组）、舒芬太尼0．5μg／kg组（S，组）、1．0μg／kg组（S：组）和2．0μg／kg组（S，组），每组15例。S1、S2、S3组于主动脉开放前5min时经主动脉根部分别输注舒芬太尼0．5、1．0和2．0μg/kg，稀释容量为2ml／kg，输注时间2min，C组用相同方法给予等容量0．9％氯化钠注射液。于麻醉诱导前（To）、主动脉开放后2h（T，）、4h（T：）、8h（T]）、24h（T4）、48h（1＇5）抽取桡动脉血，测定血浆心肌肌钙蛋白I（cTnI）、NO水平和肌酸磷酸激酶同工酶（CK—MB）、一氧化氮合酶（NOS）活力。记录患者血流动力学参数、CPB时间、主动脉阻断时间、气管导管拔出时间、ICU停留时间、术后24h心肌收缩力评分、术后24h引流量及心脏自动复跳率。结果：与C组比较：S1组T1-3，时cTnI、CK—MB均降低，NOS、NO均升高（P〈0．01）；S2、S3组T。时cTnI、CK—MB均降低，T。时NOS、NO均升高（P〈0．01），气管导管拔出时间、ICU停留时间和术后24h心肌收缩力评分均降低（P〈0．05-P〈0．01）。与s，组比较，S2、S3组T4，5时cTnI和CK-MB均降低，L3-4时NOS、NO均升高，术后24h心肌收缩力评分均降低（P〈0．05～P〈0．01）。S2与S。3差异均无统计学意义（P〉0．05）。结论：舒芬太尼后处理通过激活NOS／NO信号通路，减轻CPB心脏瓣膜置换患者心肌缺血再灌注损伤，且有剂量依赖性和封顶效应。
Objective：To investigate the role of nitric oxide（NO） in reduction of myocardial ischemia-reperfusion（I/R） injury by sufentanil postconditioning in cardiac valve replacement patients under cardiac pulmonary bypass （CPB）. Methods：Sixty patients （ASA grade II or III, NYHA class II or III ） of both sexes, aged 19-64, scheduled for cardiac valve replacement were randomly divided into 4 groups（ n = 15 each） ：control group（ group C ）, sufentanil 0.5 μg/kg group （ group S1 ）, sufentanil 1.0 μg/kg group （ group Sz ） and snfentanil 2.0 μg/kg group（ group S3 ）. In groups S1, S2 and S3, sufentanil 0.5,1.0 and 2.0 μg/kg were infused over 2 min via aortic root 5 min before aortic unclamping respectively. In group C, the equal volume of normal saline （2 ml/kg） was infused instead of sufentanil. Blood samples were taken from radial artery before induction of anesthesia（ To ） and at 2 h （ T1 ）, 4 h （ T2 ）, 8 h （ T3 ）, 24 h （T4） and 48 h （T5 ） after aortic unclamping for determination of plasma concentrations of cardiac troponin-I （cTnI） and NO and activities of creatine kinase isoenzyme-MB（CK-MB） and nitric oxide synthase（NOS）. The hemodynamic parameters, duration of CPB, time of aortic clamping, extubation time, duration of stay in ICU, and myocardial contractility score and volume of drainage at 24 h after the operation were recorded. The restoration of spontaneous heart beat were observed. Results： The plasma cTnI concentrations and CK- MB activity were significantly lower,while the plasma NO concentrations and NOS activity were significantly higher at T1-3 in group Sl than that in group C （P 〈 0.01 ）. The plasma cTnI concentration and CK-MB activity were significantly lower at T1-5 , the plasma NO concentrations and NOS activity were significantly higher at T1-4,the extubation time and duration of stay in ICU were significantly shorter, and the myocardial contractility score at 24 h after the operation were significantly lower in gr
出处
《蚌埠医学院学报》
CAS
2013年第10期1291-1295,共5页
Journal of Bengbu Medical College
关键词
再灌流损伤
心脏瓣膜置换术
心肌保护
一氧化氮
舒芬太尼
sufentanil
ischemia-reperfusion injury
cardiac valve replacement surgery
nitric oxide
myocardial protection
