CAJ | 학술논문

目的评价七氟醚预处理对体外循环(CPB)冠状动脉旁路移植术(CABG)患者左心室功能的影响.方法择期CPB下行CABG患者30例,年龄42 ～ 70岁,身高152～ 181 cm,体重43 ～ 78 kg,ASA分级Ⅱ或Ⅲ级.采用随机数字表法,将其分为2组(n=15):对照组(C组)和七氟醚预处理组(SP组).SP组在气管插管后吸入呼气末浓度相当于1 MAC七氟醚30 min.于七氟醚预处理前(T0)和停CPB后60 min(T1)时记录平均动脉压、每搏量指数、肺动脉阻塞压和TEE监测指标:左心室射血分数、E波、S波、D波的峰值和左心室舒张早期血流播散速度,计算S波与D波峰值比、E波与Vp的比值.记录气管导管拔除时间和ICU停留时间.结果与T0时比较,2组T1时HR升高(P＜0.05或0.0.01),余左心室功能指标差异无统计学意义(P＞0.05);与C组比较,SP组左心室功能各指标、气管导管拔除时间和ICU停留时间差异无统计学意义(P＞0.05).结论 CPB前吸入呼气末浓度1 MAC七氟醚预处理在左心室功能方面没有明显的心肌保护作用,对短期预后也无明显影响.
목적 평개칠불미예처리대체외순배(CPB)관상동맥방로이식술(CABG)환자좌심실공능적영향.방법 택기CPB하행CABG환자30례,년령42 ～ 70세,신고152～ 181 cm,체중43 ～ 78 kg,ASA분급Ⅱ혹Ⅲ급.채용수궤수자표법,장기분위2조(n=15):대조조(C조)화칠불미예처리조(SP조).SP조재기관삽관후흡입호기말농도상당우1 MAC칠불미30 min.우칠불미예처리전(T0)화정CPB후60 min(T1)시기록평균동맥압、매박량지수、폐동맥조새압화TEE감측지표:좌심실사혈분수、E파、S파、D파적봉치화좌심실서장조기혈류파산속도,계산S파여D파봉치비、E파여Vp적비치.기록기관도관발제시간화ICU정류시간.결과 여T0시비교,2조T1시HR승고(P＜0.05혹0.0.01),여좌심실공능지표차이무통계학의의(P＞0.05);여C조비교,SP조좌심실공능각지표、기관도관발제시간화ICU정류시간차이무통계학의의(P＞0.05).결론 CPB전흡입호기말농도1 MAC칠불미예처리재좌심실공능방면몰유명현적심기보호작용,대단기예후야무명현영향.
Objective To evaluate the effect of sevoflurane preconditioning on the left ventricular function in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).Methods Thirty ASA physical status Ⅱ or Ⅲ patients,aged 42-70 yr,with body height 152-181 cm,weighing 43-78 kg,scheduled for elective CABG under CPB,were randomly divided into 2 groups (n =15 each) using a random number table:control group (group C) and sevoflurane preconditioning group (group SP).Group SP inhaled sevoflurane with the end-tidal concentration corresponding to 1 MAC for 30 min after endotracheal intubation.Before sevoflurane preconditioning (T0) and at 60 min after termination of CPB (T1),mean arterial pressure (MAP),stroke volume index (SVI),pulmonary artery obstruction pressure and the TEE variables including left ventricular ejection fraction (LVEF),peak E wave velocity (E),systolic wave velocity (S),and diastolic wave velocity (D),and low propagation velocity (Vp) were recorded.S/D ratio and E/Vp ratio were calculated.Extubation time and duration of ICU stay were also recorded.Results Compared with the baseline value at T0,HR was significantly increased at T1 (P ＜ 0.05 or 0.01),and no significant change was found in the other parameters of the left ventricle function in the two groups (P ＞ 0.05).There was no significant difference in the parameters of the left ventricle function,extubation time and duration of ICU stay between SP group and C group (P ＞ 0.05).Conclusion Preconditioning with inhalation of sevoflurane with the end-tidal concentration corresponding to 1 MAC before CPB does not produce myocardial protection in terms of the left ventricular function or exerts little effect on the short-term outcomes.