CAJ | 학술논문

目的探讨七氟醚后处理对非体外冠脉旁路移植术(OPCABG)患者的心肌保护作用及机制.方法择期行OPCABG的患者36例,按随机数字表法分为对照组(Cont组)、七氟醚预处理组(SPC组)和七氟醚后处理组(SPO组),每组12例.三组均应用静脉麻醉药物诱导和维持.麻醉诱导后(T1)、冠脉血管重建后1 h(T2)、冠脉血管重建后6 h(T3)、冠脉血管重建后24 h(T4),分别检测血浆高敏肌钙蛋白T(TNT-hs)、N端B型脑钠肽(NT-proBNP)、肌酸磷酸激酶同工酶(CK-MB)、肿瘤坏死因子-α(TNF-α)浓度.结果三组患者均顺利完成实验,未发现明显不良反应.三组患者年龄、性别、射血分数、手术时间差异均无统计学意义(P＞0.05);三组患者血浆TNT-hs、CK-MB、TNF-α T2、T3、T4时均显著增高(P＜0.05),而NT-proBNP则T4时显著增高(P＜0.05);其中三组CK-MB、TNF-α及SPO组和SPC组TNT-hs T3时达峰值;对照组TNT-hs呈持续性升高;NT-proBNP T4时达峰值.SPO组和SPC组T3、T4时TNT-hs、CK-MB、TNF-α明显低于对照组(P＜0.05);SPC组和SPO组NT-proBNP T4时显著低于对照组(P＜0.05),其他各指标差异均无统计学意义(P＞0.05).结论 OPCABG围术期七氟醚后处理和七氟醚预处理均具有一定的心肌保护作用.
목적 탐토칠불미후처리대비체외관맥방로이식술(OPCABG)환자적심기보호작용급궤제.방법 택기행OPCABG적환자36례,안수궤수자표법분위대조조(Cont조)、칠불미예처리조(SPC조)화칠불미후처리조(SPO조),매조12례.삼조균응용정맥마취약물유도화유지.마취유도후(T1)、관맥혈관중건후1 h(T2)、관맥혈관중건후6 h(T3)、관맥혈관중건후24 h(T4),분별검측혈장고민기개단백T(TNT-hs)、N단B형뇌납태(NT-proBNP)、기산린산격매동공매(CK-MB)、종류배사인자-α(TNF-α)농도.결과 삼조환자균순리완성실험,미발현명현불량반응.삼조환자년령、성별、사혈분수、수술시간차이균무통계학의의(P＞0.05);삼조환자혈장TNT-hs、CK-MB、TNF-α T2、T3、T4시균현저증고(P＜0.05),이NT-proBNP칙T4시현저증고(P＜0.05);기중삼조CK-MB、TNF-α급SPO조화SPC조TNT-hs T3시체봉치;대조조TNT-hs정지속성승고;NT-proBNP T4시체봉치.SPO조화SPC조T3、T4시TNT-hs、CK-MB、TNF-α명현저우대조조(P＜0.05);SPC조화SPO조NT-proBNP T4시현저저우대조조(P＜0.05),기타각지표차이균무통계학의의(P＞0.05).결론 OPCABG위술기칠불미후처리화칠불미예처리균구유일정적심기보호작용.
Objective To explore mycocardial protection effect of sevoflurane post-conditioning in off-pump coronary artery bypass grafting (OPCABG) surgery,and the mechanism of mycocardial protection of sevoflurane post-conditioning.Methods Thirty six patients undergoing OPCABG were randomly divided into three groups:at 1.5 MAC (minimum alveolar concentration) for 5 minutes first,with an interruption control group (Cont group),sevoflurane preconditioning group (SPC group),and sevoflurane postconditioning group (SPO group).All patients were administrated by intravenous anesthetic drug,both for induction and maintenance.No special interventions were used in Cont group.However,in SPC group,12 patients inhaled sevoflurane for 10 minutes,then continued for 5 minutes,total 10 minutes before the anastomotic between mammary artery and anterior descending artery.In SPO group,12 patients inhaled sevoflurane at 1.5 MAC for 2 minutes before the anastomosis of last one coronary artery,and continued for 8 minutes.Four time points were focused on including T1 (accomplishment of induction),T2 (1 hour after the coronary revascularization),T3 (6 hour after the coronary revascularization),and T4 (24 hour after the coronary revascularization).Blood samples were drawn from the internal jugular vein for the measurement of the plasma concentrations of TNT-hs (highly sensitive cardiac troponin T),CK-MB (creatine phosphokinase isoenzyme),NT-proBNP (N-Terminal fragment of the prohormone Brain-Type Natri-uretic Peptide),and TNF-α (tumornecrosis factor-α).Results All the patients completed the trials without significant adverse effects.The age,gender,ejection fraction,and operative time among three groups were no statistically significant difference (P ＞ 0.05).Stay time in postoperative ICU and hospital were significantly less than Cont group (P ＜ 0.05).Compared to the pre-operative baseline,all patients'plasma concentrations of TNT-hs,CK-MB,NT-proBNP,and TNF-α were significantly increased at 1 h,6 h,and 24 h after coronary revascularization (P ＜0.05).TNT-hs in Cont group showed a persistent increase,while in other two groups (SPC and SPO),TNT-hs reached the peak concentrations at 6 hours after the coronary revascularization,which were same with CK-MB,TNF-α,and MDA in all groups;NT-proBNP reached the peak at coronary revascularization after 24 h.Compared to Cont group,TNT-hs,CK-MB,and TNF-α in groups SPC and SPO were significantly lower at 6 h,24 h after coronary revascularization; NT-proBNP was significantly lower only at 24 h after coronary revascularization.Conclusions Sevoflurane post-conditioning in OPCABG has identified myocardial protection,which was comparable with sevoflurane preconditioning.