CAJ | 학술논문

目的评价舒芬太尼后处理对体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤的影响.方法择期拟行心脏瓣膜置换术患者60例,性别不限,年龄19～64岁,ASA分级Ⅱ或Ⅲ级,心功能分级Ⅱ或Ⅲ级.采用随机数字表法,将患者随机分为4组(n=15):对照组(C组)、舒芬太尼0.5μg/kg组(S1组)、舒芬太尼1.0μg/kg组(S2组)和舒芬太尼2.0μg/ kg组(S3组).S1-3组于主动脉开放前5 min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2 ml/kg,输注时间2min,C组给予等容量生理盐水.于麻醉诱导前即刻(T2)、主动脉开放2 h(T1)、4 h(T2)、8 h(T3)、24 h(T4)和48 h(T5)时抽取桡动脉血样,测定血浆心肌肌钙蛋白I(cTnI)、丙二醛(MDA)浓度和肌酸磷酸激酶同工酶(CK-MB)、超氧化物歧化酶(SOD)活性.记录气管导管拔除时间、ICU停留时间、术后24h时心肌收缩力评分、术后24h引流量,记录心脏自动复跳及心血管不良事件发生的情况.结果与C组比较,S1组T1-3时血浆cTnI、MDA浓度和CK-MB活性降低,SOD活性升高,S2,3组T1-5时血浆cTnI浓度和CK-MB活性降低,T1-4时血浆MDA浓度降低,SOD活性升高,气管导管拔除时间和ICU停留时间缩短,术后24 h时心肌收缩力评分和心血管不良事件发生率降低(P＜0.05)；与S1组比较,S2,3组T4,5时血浆cTnI浓度和CK-MB活性降低,T4时MDA浓度降低,T3,4时SOD活性升高,术后24h时心肌收缩力评分降低(P＜0.05).结论舒芬太尼后处理可减轻体外循环下心脏瓣膜置换术患者心肌缺血再灌注损伤,其机制与抑制脂质过氧化反应有关.
목적 평개서분태니후처리대체외순배하심장판막치환술환자심기결혈재관주손상적영향.방법 택기의행심장판막치환술환자60례,성별불한,년령19～64세,ASA분급Ⅱ혹Ⅲ급,심공능분급Ⅱ혹Ⅲ급.채용수궤수자표법,장환자수궤분위4조(n=15):대조조(C조)、서분태니0.5μg/kg조(S1조)、서분태니1.0μg/kg조(S2조)화서분태니2.0μg/ kg조(S3조).S1-3조우주동맥개방전5 min시경주동맥근부분별수주서분태니0.5、1.0화2.0μg/kg,희석용량위2 ml/kg,수주시간2min,C조급여등용량생리염수.우마취유도전즉각(T2)、주동맥개방2 h(T1)、4 h(T2)、8 h(T3)、24 h(T4)화48 h(T5)시추취뇨동맥혈양,측정혈장심기기개단백I(cTnI)、병이철(MDA)농도화기산린산격매동공매(CK-MB)、초양화물기화매(SOD)활성.기록기관도관발제시간、ICU정류시간、술후24h시심기수축력평분、술후24h인류량,기록심장자동복도급심혈관불량사건발생적정황.결과 여C조비교,S1조T1-3시혈장cTnI、MDA농도화CK-MB활성강저,SOD활성승고,S2,3조T1-5시혈장cTnI농도화CK-MB활성강저,T1-4시혈장MDA농도강저,SOD활성승고,기관도관발제시간화ICU정류시간축단,술후24 h시심기수축력평분화심혈관불량사건발생솔강저(P＜0.05)；여S1조비교,S2,3조T4,5시혈장cTnI농도화CK-MB활성강저,T4시MDA농도강저,T3,4시SOD활성승고,술후24h시심기수축력평분강저(P＜0.05).결론 서분태니후처리가감경체외순배하심장판막치환술환자심기결혈재관주손상,기궤제여억제지질과양화반응유관.
Objective To investigate the effect of sufentanil postconditioning on myocardial ischemiareperfusion (I/R) injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).Methods Sixty ASA Ⅱ or Ⅲ patients ( NYHA Ⅱ or Ⅲ ) of both sexes,aged 19-64 yr,scheduled for cardiac valve rreplacement under CPB,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 S2 ) and sufentanil 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 the radial artery immediately before induction of anesthesia ( T2 ) and at 2,4,8,24 and 48 h after aortic unclamping ( T1-5 ) for determination of plasma concentrations of cardiac troponin-I (cTnI) and malondialdehyde (MDA) and activities of creatine kinase isoenzyme-MB (CK-MB) and superoxide dismutase (SOD).The 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 and adverse cardiovascular events were observed.Results The plasma cTnI,and MDA concentrations and CK-MB activity were significantly lower,while the SOD activity was significantly higher at T1-3 in group S1 than in group C ( P ＜ 0.05).The plasma cTnl concentration and CK-MB activity were significantly lower at T1-5,the plasma MDA concentration was significantly lower at T1-4,and SOD activity was 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 and incidence of adverse cardiovascular events were significantly lower in groups S2,3 than in group C ( P ＜ 0.05),The plasma cTnl concentration and CK-MB activity were significantly lower at T4,5,The plasma MDA concentration was significantly lower at T4,the SOD activity was significantly higher at T3,4,and the myocardial contractility score at 24 h after the operation was significantly lower in groups S2,3 than in group S1 ( P ＜ 0.05).Conclusion Sufentanil postconditioning can relieve myocardial I/R injury in patients undergoing cardiac valve replacement under CPB,and the mechanism is related to inhibition of lipid peroxidation.