CAJ | 학술논문

目的评价七氟醚预先给药对体外循环(CPB)下心脏瓣膜置换术患者炎性反应的影响,探讨其心肌保护作用的机制.方法择期拟行心脏瓣膜置换术的风湿性心脏病患者20例,采用随机数字表法,将患者随机分为七氟醚组(S组)和对照组(C组),每组10例.S组于主动脉阻断前吸入七氟醚,呼气末浓度1.0％,维持30 min.于切皮前、主动脉阻断即刻、主动脉开放即刻、主动脉开放后30 min、术后2、6、12、24 h(T1～8)时抽取中心静脉血样,测定血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、IL-8、细胞粘附分子-1(ICAM-1)及肌钙蛋白I(cTnI)的浓度与肌酸激酶同工酶(CK-MB)活性;并记录主动脉开放后心血管活性药物的使用情况.结果与C组比较,S组T3～8时血浆TNF-α、IL～6、IL8浓度降低,T4～8时血浆ICAM-1及cTnI浓度降低,T8时CK-MB活性降低,心血管活性药物使用率降低(P＜0.05).结论七氟醚预先给药可抑制炎性反应,对CPB下心脏瓣膜置换术患者心肌产生一定的保护作用.
목적 평개칠불미예선급약대체외순배(CPB)하심장판막치환술환자염성반응적영향,탐토기심기보호작용적궤제.방법 택기의행심장판막치환술적풍습성심장병환자20례,채용수궤수자표법,장환자수궤분위칠불미조(S조)화대조조(C조),매조10례.S조우주동맥조단전흡입칠불미,호기말농도1.0％,유지30 min.우절피전、주동맥조단즉각、주동맥개방즉각、주동맥개방후30 min、술후2、6、12、24 h(T1～8)시추취중심정맥혈양,측정혈장종류배사인자-α(TNF-α)、백세포개소-6(IL-6)、IL-8、세포점부분자-1(ICAM-1)급기개단백I(cTnI)적농도여기산격매동공매(CK-MB)활성;병기록주동맥개방후심혈관활성약물적사용정황.결과 여C조비교,S조T3～8시혈장TNF-α、IL～6、IL8농도강저,T4～8시혈장ICAM-1급cTnI농도강저,T8시CK-MB활성강저,심혈관활성약물사용솔강저(P＜0.05).결론 칠불미예선급약가억제염성반응,대CPB하심장판막치환술환자심기산생일정적보호작용.
Objective To investigate the effects of sevoflurane pretreatment on the inflammatory response in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB) and the mechanism of myocardial protection.Methods Twenty NYHA class Ⅱ or Ⅲ patients of both sexes,aged ＜ 60 yr,undergoing cardiac valve replacement with CPB,were randomly divided into 2 groups (n=10 each): sevoflurane group (group S) and control group (group C).The patients were premedicated with intramuscular morphine 0.1 mg/kg and scopolamine 0.3 mg.Anesthesia was induced with iv injection of midazolam 0.05-0.08 mg/kg,fentanyl 10-15 μg/kg and pipecuronium 0.08-0.10 mg/kg.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with intermittent iv boluses of midazolam0.03-0.06 mg/kg,fentanyl 5-10μg/kg and pipecuronium 0.04-0.08 mg/kg.Sevoflurane was inhaled before aortic clamping and the end-tidal concentration was rapidly adjusted to 1.0％ and maintained at this level for 30 min in group S.Blood samples were taken from the central vein before skin incision,immediately after aortic clamping,immediately after aortic unclamping and at 30 min after aortic unclamping,at 2,6,12 and 24 h (T1-8) after operation for determination of the concentrations of plasma tumor necrosis factor-α (TNF-α),interleukin-6 (IL) and interleukin-8 (IL-8),intercellular adhesion molecule-1 (ICAM-1),cardiac troponin I (cTnI) and activity of creatine kinase MB (CK-MB).The requirement for cardiovascular drugs was recorded after release of aortic cross clamp.Results Compared with group C,the plasma concentrations of TNF-α,IL-6 and IL-8 were significantly decreased at T3-8,the plasma concentrations of ICAM-1 and cTnl were significantly decreased at T4-8,the activity of plasma CK-MB was significantly decreased at T8,and the requirement for cardiovascular drugs was significantly reduced after release of aortic cross clamp in group S (P ＜0.05).Conclusion Sevoflurane pretreatment can inhibit the inflammatory response and provide myocardial protection to some extent in patients undergoing cardiac valve replacement with CPB.