异氟烷地氟烷预适应小儿心脏直视手术围术期心肌肌钙.docVIP

异氟烷地氟烷预适应对小儿心脏直视手术围术期心肌肌钙蛋白I的影响 刘学胜 安徽医科大学第一附属医院麻醉科 目的： 观察异氟烷或地氟烷预适应对小儿心脏直视手术中围术期心肌肌钙蛋白I释放的影响，探讨这两种吸入性麻醉药对缺血/再灌注心肌损伤的保护作用。 方法： 择期行先天性心脏病行房间隔缺损或室间隔缺损矫正术的患儿60例，随机分为异氟烷预适应组（I组，n=20）、地氟烷预适应组（D组，n=20）和对照组（C组，n=20）。三组病人都采用相同剂量芬太尼麻醉（30μg.kg-1），其中异氟烷或地氟烷预适应组在主动脉阻断前分别吸入1MAC的异氟烷或地氟烷10分钟，随后继以5分钟的洗脱期，而对照组只给予15分钟的纯氧吸入。观察麻醉前（T0），主动脉开放后即刻（T1）、2小时（T2）、6小时（T3）、24小时（T4）、48小时（T5）各时点的血浆肌酸激酶同工酶（CK-MB），心肌肌钙蛋白I（cTnI）以及主动脉开放后心脏自主复跳率。 结果： 异氟烷或地氟烷预适应组在主动脉开放后各时点血浆CK-MB值（T2,T3）及cTn-I值（T1~T5）与对照组相比有显著降低（p0.05），并且心脏自主复跳率有显著增高（p0.05）。异氟烷和地氟烷预适应组在主动脉开放后各时点血浆CK-MB及cTn-I值在各时点相比无统计学差异（p0.05）。 结论：在小儿心脏直视手术围术期，异氟烷或地氟烷预适应对缺血/再灌注心肌损伤有明显的保护作用。 关键词：异氟烷 地氟烷 预适应 心脏直视手术 缺血/再灌注损伤 心肌肌钙蛋白I Abstract Effects of isoflurane or desflurane preconditioning on myocardiac troponin I during cardiopulmonary by-pass operation in pediatrics Objective To observe the effect of isoflurane or desflurane preconditioning on myocardiac troponin I during cardiopulmonary by-pass operation in pediatrics and to investigate the action of the two volatile anesthetics against ischemia-reperfusion injury and the possible mechanism. Methods Sixrty children undergoing cardiopulmonary by-pass（CPB） operation were divided randomly into three groups(n=10): isoflurane preconditioning group (group I) and desflurane preconditioning group (group D) and control group (group C).All of The patients of three groups were mainly anesthetized by fentanyl(30μg.kg-1).The patients of group I or group D underwent 10 min of 1 minimal alveolar concentration(MAC) of isoflurane or desflurane followed by 5 min washout before aorta occluding,but the group C only underwent 15 min 100% O2 before aorta occluding.Venous blood samples were collected for the measurement of CK-MB level and myocardiac troponin I(cTnI) level perioperation.The rate hearts spontaneously rebeating of were observed. Results After reperfusion, the concentration of CK-MB(T2,T3)and cTnI (T1~T5) in group I and group D were significantly decreased compared with those in group C(P0.05), meanwhile,