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时间:2020-05-02
《不同七氟醚后处理对体外循环下冠状动脉旁路移植术患者心肌损伤的影响.pdf》由会员上传分享,免费在线阅读,更多相关内容在行业资料-天天文库。
1、中华麻醉学杂志2014年3月第34卷第3期ChinJAnesthesiol,March2014,Vo1.34,N0.3·全身麻醉·不同七氟醚后处理对体外循环下冠状动脉旁路移植术患者心肌损伤的影响王剑辉史春霞姚允泰李立环【摘要】目的评价不同七氟醚后处理对体外循环(CPB)下冠状动脉旁路移植术(CABG)患者心肌损伤的影响。方法择期CPB下CABG患者75例,年龄46~72岁,体重57~90kg,性别不限,NYI-IA心功能分级I或Ⅱ级。采用随机数字表法,将其分为5组(n:15):对照组(I组)、持续1.7%七氟醚后处理组(1a组)、持续3.4%七氟醚
2、后处理组(1Ib组)、间断1.7%七氟醚后处理组(ma组)和问断3.4%七氟醚后处理组(mb组)。i组不给予七氟醚;1Ia组于乳内动脉至冠状动脉前降支吻合口开放后由CPB机向人工膜肺中持续洗入1.7%七氟醚15min;llb组于吻合口开放后持续洗入3.4%七氟醚15min;ma组于吻合口开放后洗入1.7%七氟醚5min,停药5min后再次恢复给药5min,共计15min;Il1b组于吻合口开放后洗入3.4%七氟醚5min,停药5min后再次恢复给药5min,共计15min。于CPB前、术后6和24h时测定血浆肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶和心
3、肌肌钙蛋白I的浓度,于CPB前和停机后取右心耳组织,电镜下观察心肌超微结构。结果与I组比较,1b组术后6和24h时血浆心肌肌钙蛋白I浓度降低(P<0.05),其余血浆测定指标差异无统计学意义(P>0.05);CPB后各后处理组心肌病理学损伤程度较I组减轻,尤其Ⅱb组减轻程度显著。结论持续3.4%七氟醚15min后处理可减轻CPB下CABG患者心肌损伤。【关键词】麻醉药,吸入;缺血后处理;心肺转流术;心肌EfectofdiferentsevofluranepostcondifioningOlmyocardialinjuryinpatientsunde
4、rgoingcoronaryarterybypassgraft~withaI删olmlIl均bypassWangJianhui,ShiChunxia,YaoYuntai,LiLihuan.DepartmentofAnesthesiology,CardiovascularInstituteandFuwaiHospital,PekingUnionMedicalCollege,ChineseAcademyofMedicalSciences,&100037,ChinaCorrespondingauthor:LiLihuan,Email:llhf~@sing
5、.con【Abstract】ObjectiveToevaluatetheefectofdiferentsevofluranepostconditioningonmyocardialinjuryinpatientsundergoingcoronaryarterybypassgrafting(CABG)withcardiopulmonarybypass(CPB).MethodsSeventy—fiveNYHclass1or11patients,aged46_72yr,weighing57—90kg,scheduledforelectiveCABGwit
6、hCPB,weI-erandomlydividedinto5groups(n=15each)usingarandomnumbertable:controlgroup(groupI),postconditioningwithcontinuousadministrationof1.7%sevolquranegroup(group1Ia),pastconditioningwithcontinuousadministrationof3.4%sevofhxranegroup(groupIlla),postconditioningwithinterrupted
7、administrationof1.7%sevofluranegroup(1b)andpostconditioningwithinterruptedadministrationof3.4%sevofluranegroup(groupHIb).SevoflttranewasnotgiveningroupI.InIIagroup,aftertheanastomoticstomasoftheintemalmammaryarterytoanteriordescendingarterywerereleased.thepatientscontinuouslyi
8、nhaled1.7%sevofluranefor15min.InUbgroup,aftertheanastomoticst
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