【摘要】 目的　观察异氟醚与咪唑安定或丙泊酚联合应用对心肺转流 (CPB)心内直视手术心肌缺血 /再灌注期血清心肌肌钙蛋白Ⅰ (cTnⅠ )的影响。方法　 5 0例先心、房或室间隔缺损择期行心内直视手术患者 ,随机分为五组 ,每组 10例。Ⅰ组泵注咪唑安定 2 0～ 4 0mg·kg-1·h-1维持麻醉 ;Ⅱ组丙泊酚 0 2～ 0 4mg·kg-1·h-1;Ⅲ组转流前、主动脉开放后持续吸入 0 8～ 1 3MAC异氟醚 ;Ⅳ组转流前吸入异氟醚同Ⅲ组 ,主动脉阻断后泵注咪唑安定同Ⅰ组 ;Ⅴ组转流前同Ⅲ组 ,主动脉阻断后微泵静注丙泊酚同Ⅱ组。分别在术前、停CPB后 30分钟、2小时和术后 2 4小时取中心静脉血 ,测定血清cTnⅠ水平 ,并观察开放主动脉后心脏复跳情况。结果　与术前比较 ,五组患者停CPB后各时点cTnⅠ明显升高 (P <0 0 1)。各组术后 2 4小时值与停CPB 2小时值比较已显著下降 (P <0 0 1) ,Ⅰ组与其他各组比较升高更为显著 (P <0 0 1)。异氟醚与咪唑安定或丙泊酚联合应用 ,与异氟醚组各时点值比较 ,血清cTnⅠ未见明显降低。Ⅳ组与Ⅴ组间相比也无显著差异。各组心脏自动复跳率无差异。结论　丙泊酚减轻心肌缺血再灌注损伤的作用明显强于等效剂量的咪唑安定 ;异氟醚具有明显的心肌保护作用 ;异氟醚和丙泊酚或咪唑安定合用 ,cTnⅠ水平接近异氟?更多还原

【Abstract】 Objective To observe the cardioprotective effects of isoflurane combined with propofol or imdazolam anesthesia on myocardial ischemia reperfusion injury during open heart surgery.Methods Fifty patients,scheduled for open heart surgery,were randomly divided into five groups with 10 cases each.A infusion of midazolam 0 2 0 4mg·kg -1 ·h -1 was used in group Ⅰ,porpofol 2 0 4 0mg·kg -1 ·h -1 in group Ⅱ,a inhalation of isoflurane 0 8 1 3MAC before CPB in groups Ⅲ?Ⅳ and Ⅴ with additional infusion of midazolam 2 0 4 0mg·kg -1 ·h -1 in group Ⅳ or porpofol 2 0 4 0mg·kg -1 ·h -1 in group Ⅴ after clamping.The central venous blood samples were collected to measure the serum cardiac troponinⅠ(cTnⅠ) before operation,at 30min?2h and 24h after weaning of CPB.Rate of spontanously rebeating of the hearts was observed after reperfusion.Results As compared with those before operation,the levels of serum cTnⅠ increased significantly in five groups after weaning of CPB( P< 0 01).The serum cTnⅠ level in group Ⅰ was significantly higher than that in the others( P< 0 01).As compared with the group Ⅲ,the serum cTnⅠ levels remained unchanged in group Ⅳ and Ⅴ.Rate of spontanously rebeating of the hearts in all groups were similar after reperfusion.Conclusion Isoflurane can reduce myocardiac ischemia reperfusion injury.The cardioprotective effect of propofol is much more than that of equivalent does of midazolam.Isoflurane combined with prorofol or midazolam can not enhance the cardioprotective effects. [更多还原