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七氟醚后处理对瓣膜置换术患者心肌酶的影响
作者:王丹 冉柯 吕志平 
单位:中南大学湘雅二医院
关键词:七氟醚后处理 瓣膜置换术 心肌酶 
分类号:
出版年·卷·期(页码):2011·39·第三期(265-269)
摘要:

目的 探讨经体外循环下七氟醚后处理对瓣膜置换术患者心肌酶学的影响 方法 拟行30例体外循环下心脏瓣膜置换术患者,女19例,男11例,体重40-70kg,年龄25-65岁,ASA分级Ⅱ-Ⅲ级,随机分为对照组(C组)与七氟醚后处理组(S组)。S组于主动脉开放即刻从体外循环输氧装置开启七氟醚挥发灌以2%浓度处理15min,C组不做任何处理采用全凭静脉麻醉。分别于手术开始时(T1)、主动脉开放后0.5h(T2)、主动脉开放后3h(T3)、主动脉开放后24h(T4)4个时点采集中心静脉血,提取上清置于EP管-20℃保存。检测血清乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白(cTnI)浓度。并记录两组血流动力学、体外循环、主动脉阻断时间、手术时间和术后使用多巴胺等情况。所有数据均作统计学分析。结果:两组患者围术期血流动力学指标均保持稳定。两组患者血清LDH,CK,CK- MB,cTnI水平均较术前升高(P<0.05);与C组相比,S组LDH在T4时降低(P<0.05);cTnI在T3,T4降低(P<0.05);CK-MB在T2时点低于对照组(p<0.05);结论:体外循环七氟醚后处理可以降低心脏瓣膜置换术患者心肌酶的释放,减轻心肌缺血再灌注损伤。

Objective:To evaluate the pump after sevoflurane on heart valve replacement patients of myocardial enzyme.Method:30 patients scheduled for cardiac valve replacement under cardiopulmonary bypass patients, either sex, weighing 42-70kg, age 24 -64 years of age, ASA grade 2 or 3, were randomly divided into 2 groups (n = 15): control group (C group) and after sevoflurane treatment group (S group). S group in the aortic pump oxygen from the device instantly opens volatile sevoflurane concentration of 2% irrigation treatment 15min, C group received no treatment with total intravenous anesthesia. Measured at the beginning of the operation (T1), after aortic 0.5h (T2), aortic opening 3h (T3), aortic opening 24h (T4) when the two groups were compared before surgical incision, aortic opening 0.5 h, 3h, 24h plasma lactate dehydrogenase (LDH), creatine kinase (CK), creatine kinase (CK-MB), cardiac troponin I (cTnI) levels. Recorded in cardiopulmonary bypass surgery, aortic clamping time, operation time and postoperative use of dopamine and so on. All data were statistically analyzed.Results: Compared with the control group, in the Sevoflurane post-treatment group,LDH was lower atT4 (P<0.05). cTnI at T3, T4 decreased significantly (P<0.05); CK at T3,T4 values was less than the control group(P<0.05);CK-MB at T2 was significantly lower than the control group (p<0.05); Compared with the preoperative baseline value, two groups of plasma LDH,CK,,CK-MB,,cTnI at T1-T3 increased significantly higer than T1 (P<0.05).Conclusion::CPB under the seven isoflurane can reduce post-treatment in patients with heart valve replacement surgery the release of enzymes, can reduce myocardial ischemia-reperfusion injury.

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