【摘要】 目的观察七氟醚预处理对体外循环(CPB)下行瓣膜置换术患者心肌缺血再灌注损伤的影响。方法选择行心脏瓣膜置换术的风湿性心脏病患者30例,随机分为七氟醚预处理组(S组)和对照组(C组),每组15例。七氟醚组于手术开始后持续吸入1.1%七氟醚,至CPB开始时结束;对照组不用任何吸入性麻醉药。分别于麻醉前、主动脉开放后30 min、1 h、术后8 h和24 h抽取桡动脉血,检测血浆心肌肌钙蛋白Ⅰ(cTnI)浓度、脂质过氧化产物(MDA)含量,以及肌酸磷酸激酶(CK)、肌酸磷酸激酶同工酶(CK-MB)与超氧化物歧化酶(SOD)的活性。结果两组患者术前MDA、SOD、cTnI、CK与CK-MB均在正常范围,MDA、cTnI、CK与CK-MB在主动脉开放后各观察时点明显升高(P<0.05),SOD则明显下降(P<0.05);七氟醚组血清中MDA和cTnI在各观察时点均明显低于对照组(P<0.05),而两组SOD、CK和CK-MB比较没有明显差别。结论七氟醚预处理可以减轻心肌再灌注损伤,具有一定心肌保护作用。更多还原

【Abstract】 Objective To explore the effect of sevoflurane pretreament on cardiac enzyme in patients during value replacement surgery with cardiopulmonary bypass(CPB).Methods Thirty patients scheduled for cardiac valve replacement with CPB were randomly divided inio two groups: control group(group A,n=15) and sevoflurane preconditioning group(group B,n=15).In group B,1.1% sevoflurane was continuously inhaled from the beginning of operation to the beginning of CPB,and no anesthetic was inhaled in group A.Blood samples were collected and plasma levels of MDA,SOD,cTnI,CK and CK-MB were measured before anesthesia(T0),30 min(T1) and 1 h(T2) after release of aortic cross-clamp,8 h(T3) and 24 h(T4) after operation.Results Plasma levels of MDA,SOD,cTnI,CK and CK-MB were within normal range before operation and there were no difference between the two groups.At each period of time after reperfussion,compared with T0,levels of MDA,cTnI,CK and CK-MB in the two groups increased significantly(P<0.05).The levels of SOD in two groups decreased significantly after reperfussion(P<0.05).Compared with group A,the content of MDA,cTnI,and CK-MB were significantly lower and SOD was higher in group S(P<0.05).But the content of CK has no difference between two groups.Conclusion Preconditioning with sevoflurane in patients undergoing cardiac valve replacement under CPB has a protective effect on myocardial ischemia reperfusion.更多还原