CAJ | 학술논문

目的观察七氟醚联合胸段硬膜外阻滞对非体外循环冠状动脉搭桥术(OPCABG)患者心肌损伤的影响.方法拟行OPCABG患者40例,性别不限,年龄＜60岁,美国麻醉医师协会评分标准(A SA)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)和实验组(SE组),每组20例.SE组于T4～T5间隙行硬膜外穿刺,穿刺成功后向头端置入硬膜外导管4 cm,固定硬膜外导管.SE组患者于气管插管后吸人七氟醚并维持呼气末浓度1.5％,同时硬膜外注入0.25％左布比卡因5ml/h直至手术结束.分别于麻醉前(T0)、术毕(T1)、术后4h(T2)、8 h(T3)、12 h(T4)和24 h(T5)时,采集中心静脉血样4ml.,测定血浆心肌肌钙蛋白I(cTnI)浓度、肌酸激酶(CK)和肌酸激酶同功酶(CK-MB)的活性.结果 T2～T5时血浆cTnI浓度分别为:(5.45±1.85)、(7.34±1.88)、(7.29±1.86)、(6.85±1.89) μg/L,与C组比较,SE组T2～T5时血浆cTnI浓度降低;T2 ～T5时血浆CK浓度分别为:(35±5)、(42±8)、(54±9)、(52 ±9) U/L,与C组比较,SE组血浆CK浓度降低(P＜O.05);T2～T5时血浆CK-MB浓度分别为:(3.4±1.1)、(4.6±1.9)、(3.8±1.5)、(1.5±0.8) U/L,与C组比较,SE组血浆CK-MB浓度降低(P＜0.05).结论七氟醚联合胸段硬膜外阻滞可减轻OPCABG患者心肌的损伤.
목적 관찰칠불미연합흉단경막외조체대비체외순배관상동맥탑교술(OPCABG)환자심기손상적영향.방법 의행OPCABG환자40례,성별불한,년령＜60세,미국마취의사협회평분표준(A SA)분급Ⅱ혹Ⅲ급,채용수궤수자표법,장환자수궤분위2조(n=20):대조조(C조)화실험조(SE조),매조20례.SE조우T4～T5간극행경막외천자,천자성공후향두단치입경막외도관4 cm,고정경막외도관.SE조환자우기관삽관후흡인칠불미병유지호기말농도1.5％,동시경막외주입0.25％좌포비잡인5ml/h직지수술결속.분별우마취전(T0)、술필(T1)、술후4h(T2)、8 h(T3)、12 h(T4)화24 h(T5)시,채집중심정맥혈양4ml.,측정혈장심기기개단백I(cTnI)농도、기산격매(CK)화기산격매동공매(CK-MB)적활성.결과 T2～T5시혈장cTnI농도분별위:(5.45±1.85)、(7.34±1.88)、(7.29±1.86)、(6.85±1.89) μg/L,여C조비교,SE조T2～T5시혈장cTnI농도강저;T2 ～T5시혈장CK농도분별위:(35±5)、(42±8)、(54±9)、(52 ±9) U/L,여C조비교,SE조혈장CK농도강저(P＜O.05);T2～T5시혈장CK-MB농도분별위:(3.4±1.1)、(4.6±1.9)、(3.8±1.5)、(1.5±0.8) U/L,여C조비교,SE조혈장CK-MB농도강저(P＜0.05).결론 칠불미연합흉단경막외조체가감경OPCABG환자심기적손상.
Objective To investigate the effects of sevoflurane combined with thoracic epidural anesthesia on myocardial injury in patients undergoing off-pump coronary artery bypass grafting.Methods Forty consenting USA society of Anesthesiologists score standard (ASA) Ⅱ or Ⅲ patients undergoing offpump coronary artery bypass grafting were randomly divided into 2 groups (rt =20 each):The patients in SE group were given thoracic epidural anesthesia plus general anesthesia with 0.25％ levobupivacaine hydrochloride injection as the study group.The patients in the control group received general anesthesia only.4 ml of blood samples were taken from the central vein before skin incision (T0),at the end of operation (T1),and 4 h (T2),8 h (T3),12 h (T4) and 24 h (T5) after operation for determination of the concinase (CK)and creatin kinase isoenzyme-MB (CK-MB).Results The concenentration of serum cardiac troponin I (cTnI) at T2-T5 was (5.45 ± 1.85),(7.34 ± 1.88),(7.29 ± 1.86) and (6.85 ± 1.89) μg/L respectively in SE group,significantly lower than in the control group.The concenentration of serum CK at T2-T5 was (35 ±5),(42 ±8),(54 ±9) and (52 ±9) U/L,significantly lower in SE group than in the control group (P ＜ 0.05).The concenentration of serum CK-MB at T2-T5 was (3.4 ± 1.1),(4.6 ± 1.9),(3.8 ± 1.5)and (1.5 ± 0.8) U/L respectively,significantly lower in SE group than in the control group (P ＜ 0.05).Conclusion Sevoflurane combined with thoracic epidural anesthesia can attenuate the myocardial injury in patients undergoing off-pump coronary artery bypass grafting.