CAJ | 학술논문

目的：研究七氟醚、丙泊酚单用或联用对缺血－再灌注心肌功能的影响。方法选择2011年9月至2014年12月医院行二尖瓣置换术的风湿性心脏病患者168例，按随机数字表法分为 A 组、B 组和 C 组，各56例。3组常规麻醉诱导后，A 组采用七氟醚1.0~1.5最低有效肺泡浓度（ MAC）全程吸入维持，B 组采用丙泊酚1.5~2.0 mg / L 维持，C 组给予丙泊酚0.5~1.0 mg / L 全程靶控输注+七氟醚0.5 MAC 维持；所有患者持续静脉泵注瑞芬太尼镇痛，间断追加维库溴铵维持肌松。结果3组患者血流动力学指标心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）稳定，各时间点肌钙蛋白 I( cTnI)和肌酸磷酸激酶同工酶( CK － MB)均明显高于诱导前（ P <0.05）；A 组 cTnI 水平在 T1，T2，T3，T4各时间点，CK － MB 活性在 T2，T3，T4各时间点明显低于 B、C 组（ P <0.05）；A 组术后心脏自主复跳率、气管导管拔除时间及心肌收缩力评分均优于 B、C 组，复跳后心律失常发生率低于 B、C 组（ P <0.05）；3组住院时间无明显差异（ P >0.05）。结论七氟醚、丙泊酚单用或联用在体外循环直视下瓣膜置换手术麻醉中均可维持血流动力学稳定，满足手术需求。其中七氟醚单用在体外循环转流期间对心肌具有保护作用，且术后恢复好，复跳后心律失常发生率低。
목적：연구칠불미、병박분단용혹련용대결혈－재관주심기공능적영향。방법선택2011년9월지2014년12월의원행이첨판치환술적풍습성심장병환자168례，안수궤수자표법분위 A 조、B 조화 C 조，각56례。3조상규마취유도후，A 조채용칠불미1.0~1.5최저유효폐포농도（ MAC）전정흡입유지，B 조채용병박분1.5~2.0 mg / L 유지，C 조급여병박분0.5~1.0 mg / L 전정파공수주+칠불미0.5 MAC 유지；소유환자지속정맥빙주서분태니진통，간단추가유고추안유지기송。결과3조환자혈류동역학지표심솔（HR）、평균동맥압（MAP）、중심정맥압（CVP）은정，각시간점기개단백 I( cTnI)화기산린산격매동공매( CK － MB)균명현고우유도전（ P <0.05）；A 조 cTnI 수평재 T1，T2，T3，T4각시간점，CK － MB 활성재 T2，T3，T4각시간점명현저우 B、C 조（ P <0.05）；A 조술후심장자주복도솔、기관도관발제시간급심기수축력평분균우우 B、C 조，복도후심률실상발생솔저우 B、C 조（ P <0.05）；3조주원시간무명현차이（ P >0.05）。결론칠불미、병박분단용혹련용재체외순배직시하판막치환수술마취중균가유지혈류동역학은정，만족수술수구。기중칠불미단용재체외순배전류기간대심기구유보호작용，차술후회복호，복도후심률실상발생솔저。
Objective Research the influence of Propofol, sevoflurane alone or their combination on IRI. Methods 168 cases of rheumat-ic heart disease who underwent mitral valve replacement were chosen randomly from September 2011 to December 2014 and divided into A,B,C group, 56 cases in each group, after three conventional induction of anesthesia, A group with sevoflurane 1. 0 - 1. 5 minimum alveolar concentration effective ( MAC) to maintain full inhalation, B group with propofol 1. 5 - 2. 0 mg / L maintain the combined group given propofol 0. 5 - 1. 0 mg / L throughout the target - controlled infusion + 0. 5 MAC sevoflurane maintain; all patients by continuous in-travenous infusion of remifentanil analgesia, intermittent chase Garvey library bromine ammonium maintain muscle relaxants. Observed and recorded hemodynamic parameters (HR, MAP and CVP) changes; measuring cardiac function; records in each group of patients and hos-pital postoperative recovery time. Results Three groups of patients hemodynamically stable; three groups of patients at each time point cTnI and CK - MB activity levels were significantly higher than before induction( P < 0. 05); sevoflurane cTnI level in T1, T2, T3, T4 each time point significantly lower than the B, C group, sevoflurane CK - MB activity in T2, T3, T4 at each time point was significantly lower than the B, C group( P < 0. 05); A group after cardiac autonomic resuscitation rate, extubation time and inotropic scores were bet-ter than the B, C group; A group after resuscitation lower incidence of arrhythmias B, C group( P < 0. 05); three groups of hospital stay was no significant difference( P > 0. 05) . Conclusion Sevoflurane and propofol alone and in combination with cardiopulmonary bypass in valve replacement surgery under anesthesia can maintain hemodynamic stability, to meet the need for surgery, including sevoflurane alone during cardiopulmonary bypass on myocardium has a protective effect, and postoperative recovery, and a low incidence of arrhythmias after resuscitation, worthy of promotion.