CAJ | 학술논문

目的：观察七氟醚（Sev）预处理对体外循环下心脏瓣膜置换术（CVR）患者血清炎性细胞因子和心肌酶的影响，探讨其对心脏保护作用的可能机制。方法选择择期行CVR患者60例，ASAⅡ～Ⅲ级，随机分为对照组（ C组）和Sev预处理组（ S组），每组30例。 S组在麻醉诱导后吸入1．0％的Sev，30 min后洗脱，至体外循环（ CPB）开始时使呼气末Sev浓度均＜0．1％。用丙泊酚、咪达唑仑、舒芬太尼、维库溴铵维持麻醉， BIS值保持在40～50。 C组不吸入Sev，其余用药同S组。分别于麻醉前（ t0）、主动脉开放时（ t1）、主动脉开放后2 h （ t2）及术后24 h（ t3）采集桡动脉血，检测血清IL－6、IL－8、TNF－α、cTnI、CK、CK－MB水平。结果 t2和t3时，2组血清IL－6、IL－8和TNF－α水平均较t0和t1时明显升高（ P均＜0．05），t3时较t2时明显降低（P均＜0．05），S组t2和t3时均明显低于C组（P均＜0．05）；t0时2组血清cTnI、CK和CK－MB水平均在正常范围，t1～t3时明显升高（P均＜0．05），S组t1～t3时血清cTnI水平均明显低于C组（P均＜0．05）。结论七氟醚预处理能明显减轻CVR患者的心肌缺血再灌注损伤，其心肌保护作用机制可能与抑制炎性因子的产生和减少心肌酶的释放有关。
목적：관찰칠불미（Sev）예처리대체외순배하심장판막치환술（CVR）환자혈청염성세포인자화심기매적영향，탐토기대심장보호작용적가능궤제。방법선택택기행CVR환자60례，ASAⅡ～Ⅲ급，수궤분위대조조（ C조）화Sev예처리조（ S조），매조30례。 S조재마취유도후흡입1．0％적Sev，30 min후세탈，지체외순배（ CPB）개시시사호기말Sev농도균＜0．1％。용병박분、미체서륜、서분태니、유고추안유지마취， BIS치보지재40～50。 C조불흡입Sev，기여용약동S조。분별우마취전（ t0）、주동맥개방시（ t1）、주동맥개방후2 h （ t2）급술후24 h（ t3）채집뇨동맥혈，검측혈청IL－6、IL－8、TNF－α、cTnI、CK、CK－MB수평。결과 t2화t3시，2조혈청IL－6、IL－8화TNF－α수평균교t0화t1시명현승고（ P균＜0．05），t3시교t2시명현강저（P균＜0．05），S조t2화t3시균명현저우C조（P균＜0．05）；t0시2조혈청cTnI、CK화CK－MB수평균재정상범위，t1～t3시명현승고（P균＜0．05），S조t1～t3시혈청cTnI수평균명현저우C조（P균＜0．05）。결론칠불미예처리능명현감경CVR환자적심기결혈재관주손상，기심기보호작용궤제가능여억제염성인자적산생화감소심기매적석방유관。
Objective It is to investigate the effect of sevoflurane ( Sev) preconditioning on inflammatory cytokine and car-diac enzyme in the patients undergoing cardiac value replacement ( CVR ) and to explore the mechanism of Sev protecting heart.Methods A total of 60 ASAⅡ~Ⅲ patients under cardiopulmonary bypass for CVR ,were randomly assigned into 2 groups (n=30):control group(group C) and Sev preconditioning group(group S).Group S received 1.0% Sev after anes-thesia induction lasting for 30 min, and then being washed out until the beginning of CPB when the end tidal concentration of Sev was lower than 0.1%.Anesthesia was maintained with propofol , midazolam, sufentanil and vecuronium , BIS was main-tained at 40~50 .Group C received the same treatment as group S but no Sev preconditioning .The artery blood samples were collected to detect the serum concentration of IL -6, IL-8, TNF-αand the plasma levels of cTnI , CK and CK-MB before anesthesia (t0), at the time of aortic unclamping (t1), 2h (t2) after aortic unclamping and 24h(t3) after operation, respec-tively.Results The serum concentration of IL -6, IL-8 and TNF-αwere higher at t2 and t3 in both groups than at t0 and t1 respectively(P<0.05), they were decreased at t3 in both groups than at t2 (P<0.05) , they were significantly lower at t2 and t3 in group S than in group C (P<0.05).Plasma levels of cTnI, CK and CK-MB were within normal range at T0 in two groups, compared with t0, those in the two groups were increased significantly at t 1-t3(P<0.05), compared with the group C, they were significantly lower in the group S at t 1-t3.Conclusion Sev preconditioning could alleviate the ischemia /reperfusion injury in patients undergoing CVR , which may be related to the inhibition of inflammatory factors and the reducing of myocardial enzyme .