CAJ | 학술논문

目的评价七氟醚后处理对体外循环下心脏瓣膜置换术患者心肌氧化应激的影响.方法拟行心脏瓣膜置换术的风湿性心脏病患者50例,年龄36 ～ 59岁,体重42 ～ 71 kg,ASA分级Ⅱ或Ⅲ级,NYHA心功能Ⅱ或Ⅲ级.采用随机数字表法,将其分为2组(n=25):对照组(C组)和七氟醚后处理组(S组).S组于主动脉开放即刻经体外循环机持续输入4％七氟醚10 min,C组不使用任何吸入性麻醉药.于主动脉阻断前、主动脉开放后15、30 min、6和24 h(T1-5)时采集中心静脉血样,检测血浆心肌肌钙蛋白Ⅰ(cTnI)浓度;于体外循环开始前和体外循环结束后取左心耳心肌组织测定MDA含量和SOD活性;记录心脏复跳、再灌注心律失常评分及血管活性药物使用情况.结果与C组比较,S组体外循环结束后心肌MDA含量降低,SOD活性升高,T2-5时血浆cTnI浓度降低,心脏自动复跳率升高、再灌注心律失常评分降低,多巴胺与硝酸甘油使用量减少(P＜0.05).结论七氟醚后处理可通过减轻体外循环下心脏瓣膜置换术患者心肌氧化应激损伤而发挥心肌保护作用.
목적 평개칠불미후처리대체외순배하심장판막치환술환자심기양화응격적영향.방법 의행심장판막치환술적풍습성심장병환자50례,년령36 ～ 59세,체중42 ～ 71 kg,ASA분급Ⅱ혹Ⅲ급,NYHA심공능Ⅱ혹Ⅲ급.채용수궤수자표법,장기분위2조(n=25):대조조(C조)화칠불미후처리조(S조).S조우주동맥개방즉각경체외순배궤지속수입4％칠불미10 min,C조불사용임하흡입성마취약.우주동맥조단전、주동맥개방후15、30 min、6화24 h(T1-5)시채집중심정맥혈양,검측혈장심기기개단백Ⅰ(cTnI)농도;우체외순배개시전화체외순배결속후취좌심이심기조직측정MDA함량화SOD활성;기록심장복도、재관주심률실상평분급혈관활성약물사용정황.결과 여C조비교,S조체외순배결속후심기MDA함량강저,SOD활성승고,T2-5시혈장cTnI농도강저,심장자동복도솔승고、재관주심률실상평분강저,다파알여초산감유사용량감소(P＜0.05).결론 칠불미후처리가통과감경체외순배하심장판막치환술환자심기양화응격손상이발휘심기보호작용.
Objective To evaluate the effects of sevoflurane postconditioning on myocardial oxidative stress in the patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Fifty ASA physical status Ⅱ or Ⅲ patients (NYHA Ⅱ or Ⅲ) of both sexes,aged 36-59 yr,weighing 42-71 kg,with rheumatic heart disease undergoing cardiac valve replacement under CPB,were randomly divided into control group (group C,n =25) and sevoflurane postconditioning group (group S,n =25).In group S,4 ％ sevoflurane was infused for 10 min via the extracorporeal circulation machines starting from the time point immediately after aortic unclamping.Before aortic clamping and at 15 min,30 min,6 h,and 24 h after aortic unclamping (T1-5),blood samples were collected from the central vein for determination of the levels of cardiac troponin I (cTnI) in plasma.Myocardial specimens were taken from the left auricle before CPB and after termination of CPB for determination of malondialdehyde (MDA) content and superoxide dismutase (SOD) activity.The restoration of spontaneous heart beat,reperfusion arrhythmia scores,and requirement for vasoactive drugs were recorded.Results Compared with group C,MDA content was significantly decreased,and SOD activity was increased after termination of CPB,the plasma cTnI concentration was decreased at T2-5,the rate of restoration of spontaneous heart beat was increased,reperfusion arrhythmia scores were decreased,and the requirement for dopamine and nitroglycerin was reduced in group S.Conclusion Sevoflurane postconditioning provides myocardial protection by reducing myocardial oxidative stress injury in the patients undergoing cardiac valve replacement with CPB.