CAJ | 학술논문

目的评价体外循环(CPB)旁路洗入七氟醚对冠状动脉旁路移植术(CABG)患者心肌损伤的影响.方法择期CPB下行CABG的患者40例,年龄50 ～ 64岁,体重53～90 kg,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将患者随机分为2组(n=20):对照组(C组)和七氟醚组(S组).S组于CPB开始即刻通过体外循环机洗入1.0％～2.0％七氟醚,持续到CPB结束,C组不给予七氟醚.于麻醉诱导后5 min(T0)、术后6 h(T1)、12 h(T2)及24 h(T3)时采集血样,测定血浆心肌肌钙蛋白I(cTnI)浓度和磷酸肌酸激酶同工酶(CK-MB)活性.于主动脉阻断前和CPB结束时取右心耳组织,电镜下观察心肌超微结构,并行心肌细胞线粒体损伤评分.结果与C组比较,S组T2和T3时血浆cTnI浓度,CPB结束时心肌细胞线粒体损伤评分降低(P＜0.05),血浆CK-MB活性差异无统计学意义(P＞0.05).S组心肌病理学损伤较C组减轻.结论 CPB旁路洗入七氟醚可减轻CABG术患者的心肌损伤.
목적 평개체외순배(CPB)방로세입칠불미대관상동맥방로이식술(CABG)환자심기손상적영향.방법 택기CPB하행CABG적환자40례,년령50 ～ 64세,체중53～90 kg,ASA분급Ⅱ혹Ⅲ급,채용수궤수자표법,장환자수궤분위2조(n=20):대조조(C조)화칠불미조(S조).S조우CPB개시즉각통과체외순배궤세입1.0％～2.0％칠불미,지속도CPB결속,C조불급여칠불미.우마취유도후5 min(T0)、술후6 h(T1)、12 h(T2)급24 h(T3)시채집혈양,측정혈장심기기개단백I(cTnI)농도화린산기산격매동공매(CK-MB)활성.우주동맥조단전화CPB결속시취우심이조직,전경하관찰심기초미결구,병행심기세포선립체손상평분.결과 여C조비교,S조T2화T3시혈장cTnI농도,CPB결속시심기세포선립체손상평분강저(P＜0.05),혈장CK-MB활성차이무통계학의의(P＞0.05).S조심기병이학손상교C조감경.결론 CPB방로세입칠불미가감경CABG술환자적심기손상.
Objective To investigate the effects of sevoflurane wash-in during cardiopulmonary bypass (CPB) on myocardial injury in patients undergoing coronary artery bypass grafting(CABG).Methods Forty ASA Ⅱ or Ⅲ patients aged 50-64 yr,weighing 53-90 kg undergoing scheduled for CABG under CPB were randomly divided into 2 groups (n =20): control group (group C) and sevoflurane group(group S).Anesthesia was maintained with propofol 3-5 mg·kg-1 ·h-1 and sufentanil 0.5-1.0 μg·kg-1 ·h-1 in both groups.Sevoflurane 1％-2％ was washed into extracorporeal circuit during CPB in group S.Blood samples were taken from central vein after the induction of anesthesia (T0,baseline) and at 6,12 and 24 h (T1-3) after operation for determination of plasma cardiac troponin I(cTnI) concentration and creatine kinase-MB (CK-MB) activity.Myocardial specimens were obtained from right auricle before aortic cross-clamping and at the end of CPB for ultrastructure examination.The severity of mitochondria injury was assessment and scored (0 =normal,4 =impaired inner mitochondrial membrane integrity).Results CPB significantly increased plasma cTnI concentration at T1-3 as compared with the baseline values at T0 before CPB.Plasma cTnI concentration was significantly lower at T2 and T3 in group S than in group C.Mitochondrial injury index was significantly lower at the end of CPB in group S than in group C.There was no significant difference in plasma CK-MB activity between the 2 groups.Conclusion Wash-in of sevoflurane during CPB can attenuate myocardial injury in patients undergoing CABG.