异丙酚及七氟烷对小儿体外循环心肌保护作用对比探究.docVIP

异丙酚及七氟烷对小儿体外循环心肌保护作用对比探究【摘要】 目的 比较异丙酚和七氟烷对小儿体外循环心的肌保护作用。方法 40例先天性心脏病患儿随机分成2组，每组20例。麻醉诱导后，异丙酚组采用异丙酚麻醉维持，七氟烷组采用七氟烷麻醉维持，所有患儿于麻醉前、体外循环结束后、到达ICU即刻、术后6 h、12 h及24 h抽取静脉血，测定血浆肌钙蛋白I（cTnI）及心肌酶CK-MB。结果 两组患儿术前基础值血浆CK-MB和cTnI浓度差异无统计学意义；与术前基础值相比，两组患儿体外循环结束后、T0、T6、T12及T24显著升高；与异丙酚组相比，七氟烷组体外循环结束后、T0、T6、T12及T24显著降低。结论 七氟烷对小儿体外循环心肌保护作用优于异丙酚。 【关键词】 异丙酚;七氟烷;体外循环;心肌保护 Comparison oftheeffects ofSevoflurane and Propofolon Myocardial preservation during cardiopulmonary bypass in pediatric Patients ZHANG Chun-yuan,CHEN Yong,ZHANG Zhi-gang.Department of Anesthesiology,Zhongshan Hospital of Sun Yat-Sen University,Guangdong 528403,China 【Abstract】 Objective To compare the effects ofSevoflurane and Propofolon myocardial preservation during cardiopulmonary bypass（CPB） in pediatric patients.Methods 40 cases pediatric patients with congenital heart disease were randomly divided into two groups with 20 patients each. After induction of anesthesia, Anesthesia was maintained with Propofol in the Propofol group, while Sevoflurane was maintained in the Sevoflurane group. Blood samples were taken before operation,after CPB,ICU arrival（T0）,6 h（T6）,12 h（T12）,24 h（T24） after surgery to determine creatine kinase isoenzyme MB（CK-MB） and cardiac troponin（cTnI） concentrations. Results The concentrations of CK-MB and cTnI at before operation were no differences between two groups. CK-MB and cTnI at after CPB, T0,T6,T12,T24 were significantly increased.While CK-MB and cTnI in the Sevoflurane group were significantly lower than those in the Propofol group at after CPB, T0,T6,T12,T24.Conclusion Sevoflurane is better myocardial preservation than propofol during CPB in pediatric patients. 【Key words】 Propofol;Sevoflurane;Cardiopulmonary bypass;Myocardial preservation 作者单位：528403 中山大学附属中山医院麻醉科 体外循环（CPB）是心内直视手术的一种重要手段。体外循环下由于全身炎症反应和缺血再灌注损伤而导致心肌损害，特别是小儿患者［1］。心脏直视手术并发症的发生率和病死率均与心肌受损程度密切相关。因此手术过程中如何实施良好的心肌保护、减少缺血引起的损害一直是心脏外科领域的重要课题。本研究旨在比较异丙酚和七氟烷对小儿体外循环心肌保护作用。 1 资料与方法 1.1 一般资料 40例先天性心脏病患儿,全部为左向右分流