CAJ | 학술논문

目的探讨非体外循环下异氟醚麻醉对肾下型腹主动脉瘤患者心肌的保护作用.方法 80例腹主动脉瘤患者,行常温非体外循环下腹主动脉置换术,随机分为异氟醚组和七氟醚组,各40例,记录入手术室时、切皮时、进入腹腔时及手术结束时心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)和术中心血管不良事件发生;检测切皮时、手术结束时、术后2h及术后4h血浆肌酸激酶同工酶(CK-MB)及心肌肌钙蛋白Ⅰ(cTnⅠ)的浓度.结果异氟醚组心血管不良事件(52例)与七氟醚组(65例)发生率差异无统计学意义(P＞0.05);进入腹腔时异氟醚组HR[(63.5 ±5.0)次/分]及MAP[(84.3±3.9)mmHg(1 mmHg=0.133 kPa)]高于七氟醚组[(59.5±5.0)次/分及(78.4±4.1) mmHg,P＜0.05],手术结束时异氟醚组MAP[(73.8±3.1) mmHg]高于七氟醚组[(70.8±5.8) mmHg,P＜0.05];手术结束时异氟醚组cTnⅠ[(0.99±0.22) μg/L]低于七氟醚组[(1.17±0.29) μg/L,P＜0.05],术后2h异氟醚组CK-MB[(2.33 ±0.67) U/L]和cTnⅠ[(1.03 ±0.31) μg/L]低于七氟醚组[(2.98 ±0.36) U/L和(1.38±0.33) μg/L,P＜0.05],术后4h异氟醚组CK-MB[(3.09±0.51) U/L和cTnⅠ[(1.15 ±0.42) μg/L]也低于七氟醚组[(5.87 ±0.23) U/L和(1.53 ±0.62) μg/L,P ＜0.05].结论在常温非体外循环下行腹主动脉瘤开放手术时,麻醉药物异氟醚具有较好的保护心肌,减轻心肌缺血再灌注损伤的作用.
목적 탐토비체외순배하이불미마취대신하형복주동맥류환자심기적보호작용.방법 80례복주동맥류환자,행상온비체외순배하복주동맥치환술,수궤분위이불미조화칠불미조,각40례,기록입수술실시、절피시、진입복강시급수술결속시심솔(HR)、평균동맥압(MAP)、중심정맥압(CVP)화술중심혈관불량사건발생;검측절피시、수술결속시、술후2h급술후4h혈장기산격매동공매(CK-MB)급심기기개단백Ⅰ(cTnⅠ)적농도.결과 이불미조심혈관불량사건(52례)여칠불미조(65례)발생솔차이무통계학의의(P＞0.05);진입복강시이불미조HR[(63.5 ±5.0)차/분]급MAP[(84.3±3.9)mmHg(1 mmHg=0.133 kPa)]고우칠불미조[(59.5±5.0)차/분급(78.4±4.1) mmHg,P＜0.05],수술결속시이불미조MAP[(73.8±3.1) mmHg]고우칠불미조[(70.8±5.8) mmHg,P＜0.05];수술결속시이불미조cTnⅠ[(0.99±0.22) μg/L]저우칠불미조[(1.17±0.29) μg/L,P＜0.05],술후2h이불미조CK-MB[(2.33 ±0.67) U/L]화cTnⅠ[(1.03 ±0.31) μg/L]저우칠불미조[(2.98 ±0.36) U/L화(1.38±0.33) μg/L,P＜0.05],술후4h이불미조CK-MB[(3.09±0.51) U/L화cTnⅠ[(1.15 ±0.42) μg/L]야저우칠불미조[(5.87 ±0.23) U/L화(1.53 ±0.62) μg/L,P ＜0.05].결론 재상온비체외순배하행복주동맥류개방수술시,마취약물이불미구유교호적보호심기,감경심기결혈재관주손상적작용.
Objective To study the protective effect of isoflurane on myocardia in patients with abdominal aortic aneurysm under extracorporeal circulation.Methods A total of 80 patients with abdominal aortic aneurysm who took abdominal aorta replacement surgery under the normal temperature and extracorporeal circulation were randomly divided into isoflurane group or sevoflurane group (n =40 each).The heart rate (HR),mean arterial pressure (MAP) and central venous pressure (CVP) were recorded on the time points of entering the operation room,cutting skin,entering the abdominal cavity,and completing the operation,meanwhile cardiac adverse events during the whole operation were also recorded.Plasma concentration of creatine kinase-MB (CK-MB) and cardiac troponin Ⅰ (cTnⅠ) at the time points of cutting skin,end of the operation,2 h and 4 h after operation.Results The incidence of cardiovascular adverse events between isoflurane group (52 cases) and sevoflurane group (65 cases) had no significant difference (P ＞0.05).When getting into the abdominal cavity,HR [(63.5 ±5.0) beats/min] and MAP [(84.3 ±3.9) mmHg (1 mmHg =0.133 kPa)] in isoflurane group were increased as compared with sevoflurane group [(59.5 ± 5.0) beats/min and (78.4 ± 4.1) mmHg],and at the end of the surgery the MAP [(73.8 ± 3.1) mmHg] in isoflurane group was higher than in sevoflurane group [(70.8 ± 5.8) mmHg,P ＜0.05].The cTnⅠ in isoflurane group [(0.99 ± 0.22) μg/L] was lower than in sevoflurane group [(1.17 ±0.29) μg/L] at the end of the surgery (P ＜0.05).At 2 h postoperation,the plasma CK-MB [(2.33 ±0.67) U/L] and eTnⅠ [(1.03 ± 0.31) μg/L] in isoflurane group were lower than in sevoflurane group [(2.98 ± 0.36) U/L and (1.38 ± 0.33) μg/L,P ＜ 0.05],and at 4 h postoperation the C K-MB [(3.09 ± 0.51) U/L] and cTnⅠ [(1.15 ± 0.42) μg/L] in isoflurane group were lower than in sevofluranegroup [(5.87±0.23) U/Land (1.53±0.62) μg/L,P＜0.05].Conclusion Inthe treatment of abdominal aortic aneurysm under the normal temperature of extracorporeal circulation,isoflurane as an anesthesia drug is more potent protection on myocardium.It can also reduce the effect of myocardial ischemia-reperfusion injury.