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异氟醚预处理对婴幼儿体外循环后心肌的保护作用(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2008年第4期
页码:
478-481
栏目:
临床研究
出版日期:
2008-08-20

文章信息/Info

Title:
Myocardial protective effects of pretreatment with isoflurane during open heart surgery in infants under cardiopulmonary bypass
作者:
顾春虎1; 王云雅2; 陈敏3; 魏旭峰1; 刘金成1; 董小超1; 刘洋1; 易定华1
第四军医大学西京医院： 1.心脏外科,2.核医学科,3.麻醉科,陕西 西安 710032
Author(s):
GU Chunhu1;  WANG Yunya2;  CHEN Min3;  WEI Xvfeng1;  LIU Jincheng1;  DONG Xiaochao1;  LIU Yang1;  YI Dinghua1
1.Department of Cardiovascular Surgery, 2.Department of Nuclear Medicine, 3.Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, Shaanxi, China
关键词:
异氟醚; 预处理; 体外循环; 降钙素基因相关肽; 内皮素; 心房钠尿肽; 心肌钙蛋白
Keywords:
isoflurane;  preconditioning;  cardiopulmonary bypass;  calcitonin gene related peptide;  atrial natriuretic peptide;  endothelin;  cardiac troponin I
分类号:
R654.1
DOI:
-
文献标识码:
A
摘要:
目的 观察异氟醚预处理对体外循环下婴幼儿心内直视手术心肌的保护作用。方法 将100 例先天性心脏病患儿,随机分为预处理组和对照组,观察两组转机时间、主动脉阻断时间、心脏复跳情况、循环情况。分别于麻醉后、体外循环主动脉开放后15 min、4 h、24 h时间点取血样,检测血清降钙素基因相关肽(CGRP)、内皮素(ET)、心房钠尿肽(ANP)、心肌钙蛋白(cTnI) 的变化。结果 两组转机时间、主动脉阻断时间、开放至复跳时间无显著差异,预处理组的自动复跳率、复跳后低血压发生率及术后24 h低血压发生率均优于对照组(P<005)。主动脉开放15 min后,CGRP和ANP 在两组患者均显著增高(P<001),但预处理组明显高于对照组(P<005);ET和cTnI在主动脉开放后也显著上升(P<001),但预处理组上升幅度明显低于对照组(P<005)。结论 异氟醚预处理能减少心肌的缺血/再灌注损伤,促进体外循环后心功能恢复。
Abstract:
AIM To investigate the myocardial protective effects of pretreatment with isoflurane during open heart surgery in infants under cardiopulmonary bypass (CPB). METHODS One hundred infants with congenital heart disease undergoing cardiac operation were randomized into isoflurane preconditioning group (n=50) and control group (n=50). Blood samples were taken for the measurement of CGRP, ET, ANP and cTnI after anesthesia (before CPB), at 15 min after aortic declamping and 4 and 24 hours after the termination of CPB. The aortic clamping time and CPB time were recorded. The state of circulation and the heart spontaneous return were observed. RESULTS There were no significant differences in duration of bypass, aortic cross clamping time and the time from aortic opening to resumption of heart beating between preconditioning group and control group. Incidence of spontaneous resuscitation was higher in preconditioning group than that in control group (P<005). Incidence of hypotenion after resumption of heart beating and in the following 24 h was lower in group Ⅰ than that in control group (P<005). The CGRP and ANP levels of preconditioning group and control group significantly increased at 15 min after aortic opening as compared with those before CPB (P<001). But the CGRP and ANP levels of preconditioning group were higher than those of control group. Compared with the concentrations of ET1 and cTnI before CPB, the levels increased significantly after aortic opening (P<001). However, the ET1 and cTnI levels of preconditioning group were lower than those of control group (P<005). CONCLUSION Isoflurane preconditioning protects against myocardium injury during open heart surgery in infants under cardiopulmonary bypass.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2007-09-24.基金项目：国家科技支撑计划项目资助（200BAI01A08） 通讯作者：易定华，主任医师，主要从事心脏外科,组织工程,体外循环等研究Email:yidh@fmmu.edu.cn 作者简介：顾春虎，主治医生，博士Email:guchunhu@fmmu.edu.cn
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