南方医科大学学报
南方醫科大學學報
남방의과대학학보
JOURNAL OF SOUTHERN MEDICAL UNIVERSITY
2009年
8期
1554-1556
,共3页
徐忠东%金沐%何伟雄%夏淑轩%赵一凡%何波%曹德雄%彭书崚%李珏%曹铭辉
徐忠東%金沐%何偉雄%夏淑軒%趙一凡%何波%曹德雄%彭書崚%李玨%曹銘輝
서충동%금목%하위웅%하숙헌%조일범%하파%조덕웅%팽서릉%리각%조명휘
心肌肌钙蛋白I%瑞芬太尼%非体外循环冠状动脉旁路移植术%缺血预处理%心肌再灌注损伤
心肌肌鈣蛋白I%瑞芬太尼%非體外循環冠狀動脈徬路移植術%缺血預處理%心肌再灌註損傷
심기기개단백I%서분태니%비체외순배관상동맥방로이식술%결혈예처리%심기재관주손상
cardiac troponin I%remifentanil%off-pump coronary artery bypass grafting%ischemic preconditioning%myocardial reperfusion injury
目的 应用心肌肌钙蛋白I(cTnI)评价瑞芬太尼预处理对非体外循环冠脉搭桥(OPCAB)患者的心肌保护作用.方法 选择24例行OPCAB的冠心病患者,随机分为瑞芬太尼预处理组(R组)和对照组(C组).所有患者术前口服安定10mg,肌肉注射吗啡10mg、东莨菪碱0.3 mg,全麻诱导静脉注射咪唑安定0.08 mg/kg,依托咪酯0.1～0.3 mg/kg,芬太尼5～10 μg/kg,罗库溴铵1 mg/kg诱导,吸人1 MAC异氟醚,持续静脉输注异丙酚0.8~2μ/ml;间断给予芬太尼5～10μg/kg,哌库溴铵0.05 mg/kg.R组:瑞芬太尼5 μg/kg溶于50 ml生理盐水,于麻醉诱导后10 min恒速泵完.C组:泵注同等容量生理盐水.测定术前、术毕及术后1、6、24、48h血浆cTnI水平.结果 各组内术后cTnI水平均明显增高(P<0.05).R组术后cTnI水平显著低于C组(P<0.05).结论 瑞芬太尼预处理可降低OPCAB患者的cTnI水平,减轻心肌损伤.
目的 應用心肌肌鈣蛋白I(cTnI)評價瑞芬太尼預處理對非體外循環冠脈搭橋(OPCAB)患者的心肌保護作用.方法 選擇24例行OPCAB的冠心病患者,隨機分為瑞芬太尼預處理組(R組)和對照組(C組).所有患者術前口服安定10mg,肌肉註射嗎啡10mg、東莨菪堿0.3 mg,全痳誘導靜脈註射咪唑安定0.08 mg/kg,依託咪酯0.1～0.3 mg/kg,芬太尼5～10 μg/kg,囉庫溴銨1 mg/kg誘導,吸人1 MAC異氟醚,持續靜脈輸註異丙酚0.8~2μ/ml;間斷給予芬太尼5～10μg/kg,哌庫溴銨0.05 mg/kg.R組:瑞芬太尼5 μg/kg溶于50 ml生理鹽水,于痳醉誘導後10 min恆速泵完.C組:泵註同等容量生理鹽水.測定術前、術畢及術後1、6、24、48h血漿cTnI水平.結果 各組內術後cTnI水平均明顯增高(P<0.05).R組術後cTnI水平顯著低于C組(P<0.05).結論 瑞芬太尼預處理可降低OPCAB患者的cTnI水平,減輕心肌損傷.
목적 응용심기기개단백I(cTnI)평개서분태니예처리대비체외순배관맥탑교(OPCAB)환자적심기보호작용.방법 선택24례행OPCAB적관심병환자,수궤분위서분태니예처리조(R조)화대조조(C조).소유환자술전구복안정10mg,기육주사마배10mg、동랑탕감0.3 mg,전마유도정맥주사미서안정0.08 mg/kg,의탁미지0.1～0.3 mg/kg,분태니5～10 μg/kg,라고추안1 mg/kg유도,흡인1 MAC이불미,지속정맥수주이병분0.8~2μ/ml;간단급여분태니5～10μg/kg,고고추안0.05 mg/kg.R조:서분태니5 μg/kg용우50 ml생리염수,우마취유도후10 min항속빙완.C조:빙주동등용량생리염수.측정술전、술필급술후1、6、24、48h혈장cTnI수평.결과 각조내술후cTnI수평균명현증고(P<0.05).R조술후cTnI수평현저저우C조(P<0.05).결론 서분태니예처리가강저OPCAB환자적cTnI수평,감경심기손상.
Objective To investigate the value of cardiac troponin I (cTnI) levels in assessing myocardial protection by remifentanil precondition against myocardial. injury induced by off-pump coronary artery bypass (OPCAB). Methods Twenty-four patients undergoing OPCAB were randomized into control and remifentanil preconditioning group (n=12). All the patients received pretreatment with oral diazepam (10 mg), intramuscular morphine (10 mg) and hyosine (0.3 mg). General anesthesia was induced with midazolam (0.08 mg/kg), etomidate (0.1-0.3 mg/kg), fentanyl (5-10 (μg/kg), and rocuronium (1mg/kg), and maintained with isoflurane inhalation and propofol infusion. Intermittent fentanyl and pipecuronium were given intravenously, In remifentanil preconditioning group, remifentanil (5 μg/kg in 50 ml normal saline) was infused in 10 min after anesthesia induction, and only NS was administered in the control group. Blood samples were obtained before and at 0, 2, 6,24, and 48 h after the operation to determine serum cTnI evels. Results In both of the two groups, the cTnI levels increased significantly at the postoperative time points (0, 2, 6, 24, and 48 h) as compared with those before the operation (P<0.05). The cTnI levels of remifentanil preconditioning group were markedly decreased after the operation in comparison with those of the control group (P<0.05). Conclusion Remifentanil preconditioning decreases the cTnI levels and reduces myocardial injury induced by OPCAB.
