【摘要】 目的:研究在行非体外循环冠状动脉旁路移植术(OPCABG)时,舒芬太尼对心肌的保护作用。方法:择期行OPCABG的患者60例,年龄52～75岁,ASAⅡ或Ⅲ级,随机分为舒芬太尼组和芬太尼组,每组30例。舒芬太尼组用舒芬太尼1μg/kg,芬太尼组用芬太尼10μg/kg进行麻醉诱导,分别于切皮、劈胸骨、钳夹主动脉侧壁、关胸前追加舒芬太尼每次0.8μg/kg(舒芬太尼组)或芬太尼每次8μg/kg(芬太尼组)维持麻醉。于麻醉诱导前(T0)、桥血管吻合结束(T1)、手术结束即刻(T2)、术毕8、16和24 h(T3-5),采集桡动脉血10 ml分离血清,用酶联免疫法分别测定两组患者血清IL-6、IL-10、CK-MB、心肌肌钙蛋白I(cTnI)水平及超氧化物歧化酶(SOD)活性。结果:与芬太尼组比较,舒芬太尼组血清cTnI水平在T4～5时显著降低(P<0.05),IL-6水平在T1～4时降低(P<0.05),IL-10在T1～4时升高(P<0.05),SOD活性在T1～3时升高(P<0.05)。结论:舒芬太尼对OPCABG的心肌具有保护作用,其机制可能与抗炎、清除自由基、减少氧化应激等有关。更多还原

【Abstract】 Objective: To evaluate the myocardial protective effects of sufentanil in patients received off-pump coronary artery bypass grafting(OPCABG).Methods: Sixty patients,who aged 52 to 75 years with ASA II or III,for selected OPCABG operation were randomly divided into the sufentanil group(Group S) and fentanyl group(Group F).Sufentanil(1μg/kg) and Fentanyl(10μg/kg) were used in Group S and Group F,respectively,during anesthesia induction.Sufentanil(0.8μg/kg) and fentanyl(8μg/kg) were also applied for anesthesia maintenance at skin incision,sternotomy,clamping aortic sidewall,and the end of operation in Group S and Group F,respectively.The radial artery blood samples were obtained before induction of anesthesia(T0),at the end of the blood vessels suture(T1),at the end of operation(T2),and 8,16 and 24 hours after operation(T3-5).The interleukin-6(IL-6),interleukin-10(IL-10),creatine kinase isoenzyme-MB(CK-MB),and cardiac troponin I(cTnI) concentrations,and activity of superoxide dismutase(SOD) were assessed with enzyme-linked immunosorbent assay.Results: In Group F,the concentrations of cTnI were significantly lower than those in Group S at T4-5,with significantly lower IL-6 between T1-4,significantly higher IL-10 between T1-4,and significantly higher activity of SOD between T1-3(P<0.05).Conclusion: Sufentanil provides myocardial protection in the OPCABG,probably via anti-inflammatory,scavenging free radicals,and reducing oxidative stress.更多还原