CAJ | 학술논문

目的：评价不同七氟醚后处理对体外循环（CPB ）下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 CABG患者75例，年龄46～72岁，体重57～90 kg ，性别不限， NYHA心功能分级Ⅰ或Ⅱ级。采用随机数字表法，将其分为5组（ n＝15）：对照组（Ⅰ组）、持续1.7％七氟醚后处理组（Ⅱa组）、持续3.4％七氟醚后处理组（Ⅱb组）、间断1.7％七氟醚后处理组（Ⅲa组）和间断3.4％七氟醚后处理组（Ⅲb组）。Ⅰ组不给予七氟醚；Ⅱa组于乳内动脉至冠状动脉前降支吻合口开放后由CPB机向人工膜肺中持续洗入1.7％七氟醚15 min；Ⅱb组于吻合口开放后持续洗入3.4％七氟醚15 min；Ⅲa组于吻合口开放后洗入1.7％七氟醚5 min ，停药5 min后再次恢复给药5 min ，共计15 min；Ⅲb组于吻合口开放后洗入3.4％七氟醚5 min ，停药5 min后再次恢复给药5 min ，共计15 min。于CPB前、术后6和24 h时测定血浆肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶和心肌肌钙蛋白I的浓度，于CPB前和停机后取右心耳组织，电镜下观察心肌超微结构。结果与Ⅰ组比较，Ⅱb组术后6和24 h时血浆心肌肌钙蛋白I浓度降低（ P＜0.05），其余血浆测定指标差异无统计学意义（ P＞0.05）；CPB后各后处理组心肌病理学损伤程度较Ⅰ组减轻，尤其Ⅱb组减轻程度显著。结论持续3.4％七氟醚15 min后处理可减轻CPB下CABG患者心肌损伤。
목적：평개불동칠불미후처리대체외순배（CPB ）하관상동맥방로이식술（CABG ）환자심기손상적영향。방법택기CPB하 CABG환자75례，년령46～72세，체중57～90 kg ，성별불한， NYHA심공능분급Ⅰ혹Ⅱ급。채용수궤수자표법，장기분위5조（ n＝15）：대조조（Ⅰ조）、지속1.7％칠불미후처리조（Ⅱa조）、지속3.4％칠불미후처리조（Ⅱb조）、간단1.7％칠불미후처리조（Ⅲa조）화간단3.4％칠불미후처리조（Ⅲb조）。Ⅰ조불급여칠불미；Ⅱa조우유내동맥지관상동맥전강지문합구개방후유CPB궤향인공막폐중지속세입1.7％칠불미15 min；Ⅱb조우문합구개방후지속세입3.4％칠불미15 min；Ⅲa조우문합구개방후세입1.7％칠불미5 min ，정약5 min후재차회복급약5 min ，공계15 min；Ⅲb조우문합구개방후세입3.4％칠불미5 min ，정약5 min후재차회복급약5 min ，공계15 min。우CPB전、술후6화24 h시측정혈장기산격매、기산격매동공매、유산탈경매화심기기개단백I적농도，우CPB전화정궤후취우심이조직，전경하관찰심기초미결구。결과여Ⅰ조비교，Ⅱb조술후6화24 h시혈장심기기개단백I농도강저（ P＜0.05），기여혈장측정지표차이무통계학의의（ P＞0.05）；CPB후각후처리조심기병이학손상정도교Ⅰ조감경，우기Ⅱb조감경정도현저。결론지속3.4％칠불미15 min후처리가감경CPB하CABG환자심기손상。
Objective To evaluate the effect of different sevoflurane postconditioning on myocardial injury in patients undergoing coronary artery bypass grafting (CABG ) with cardiopulmonary bypass (CPB ) .Methods Seventy-five NYHA class Ⅰ or Ⅱ patients ,aged 46-72 yr ,weighing 57-90 kg ,scheduled for elective CABG with CPB ,were randomly divided into 5 groups ( n=15 each) using a random number table :control group (groupⅠ) , postconditioning with continuous administration of 1.7% sevoflurane group (groupⅡ a ) , postconditioning with continuous administration of 3.4% sevoflurane group (group Ⅲa) ,postconditioning with interrupted administration of 1.7% sevoflurane group (Ⅱb) and postconditioning with interrupted administration of 3.4% sevoflurane group (group Ⅲb) .Sevoflurane was not given in group Ⅰ .In Ⅱa group ,after the anastomotic stomas of the internal mammary artery to anterior descending artery were released ,the patients continuously inhaled 1.7% sevoflurane for 15 min .In Ⅱb group ,after the anastomotic stomas were released .In Ⅲa group ,after the anastomotic stomas were released , the patients continuously inhaled 3.4% sevoflurane for 15 min , the patients inhaled 1.7%sevoflurane for 5 min first ,inhalation was interrupted for 5 min ,and then inhalation was recovered lasting for 5 min ,and it was 15 min in total .In Ⅲb group ,after the anastomotic stomas were released ,the patients inhaled 3.4% sevoflurane for 5 min first ,inhalation was interrupted for 5 min ,and then inhalation was recovered lasting for 5 min ,and it was 15 min in total .Venous blood samples were taken for determination of the plasma creatine kinase ,creatine kinase isoenzyme-MB , lactic dehydrogenase , and cardiac troponin I concentrations before CPB and at 6 and 24 h after operation .Myocardial specimens were obtained from the right auricle before CPB and after termination of CPB for microscopic examination of the ultrastructure .Results Compared with group Ⅰ , the concentration of cardiac troponin Ⅰ was significantly decreased at 6 and 24 h after operation ( P<0.05) ,and no significant changes were found in the other parameters in Ⅱb group ( P>0.05 ) .The pathological changes were significantly attenuated in sevoflurane postconditioning groups as compared with group Ⅰ ,especially in Ⅱb group . Conclusion Postconditioning with continuous administration of 3.4% sevoflurane for 15 min can attenuate myocardial damage in patients undergoing CABG with CPB .