上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (9): 1316-.doi: 10.3969/j.issn.1674-8115.2011.09.024

• 论 著 • 上一篇    下一篇

七氟醚预处理和后处理对婴幼儿体外循环心肌再灌注损伤的影响

孙 瑛, 朱 明, 张剑蔚, 许文音, 白 洁, 张马忠   

  1. 上海交通大学 医学院附属上海儿童医学中心麻醉科, 上海 200127
  • 出版日期:2011-09-28 发布日期:2011-09-27
  • 通讯作者: 张马忠, 电子信箱: doctorzmz@tom.com。
  • 作者简介:孙 瑛（1970—）, 女, 副主任医师, 博士, 硕士生导师；电子信箱: yingsun821@yahoo.com.cn。
  • 基金资助:

    上海市科委基金（08411960800）

Effects of sevoflurane preconditioning and postconditioning on myocardial reperfusion injury under cardiopulmonary bypass in infants

SUN Ying, ZHU Ming, ZHANG Jan-wei, XU Wen-yin, BAI Jie, ZHANG Ma-zhong   

  1. Department of Anesthesiology, Shanghai Children Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
  • Online:2011-09-28 Published:2011-09-27
  • Supported by:

    Shanghai Science and Technology Committee Foundation, 08411960800

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摘要：

目的 探讨七氟醚预处理、后处理和预处理复合后处理对婴幼儿先天性心脏病手术中体外循环心肌再灌注损伤的影响。方法 选择60例室间隔缺损行心内直视手术的患儿，随机分为对照组（整个麻醉过程中不应用吸入麻醉药）、预处理组（主动脉阻断前吸入1.5 MAC的七氟醚20 min）、后处理组（主动脉开放后吸入1.5 MAC的七氟醚20 min）和预处理+后处理组（主动脉阻断前后分别吸入1.5 MAC的七氟醚20 min），每组15例。记录和比较各组主动脉阻断时间、体外循环时间、手术时间和入心脏重症监护病房（CICU）后的呼吸机支持时间、CICU滞留时间以及住院时间；分别于麻醉诱导后（T0）、体外循环开始前（T1）、体外循环结束即刻（T2）和体外循环后1 h（T3）、6 h（T4）、12 h（T5）、24 h（T6），测定心肌损伤标志物血浆心肌肌钙蛋白Ⅰ（cTnⅠ）、肌红蛋白（Mb）和肌酸激酶同工酶（CKMB）的质量浓度。结果 各组间主动脉阻断时间、体外循环时间、手术时间、入CICU后的呼吸机支持时间、CICU滞留时间及住院时间比较，差异均无统计学意义（P>0.05）。各组T2 ~T6时点的血浆cTnⅠ、Mb和CK-MB质量浓度均显著高于T0时点（P<0.05）；预处理组、后处理组和预处理+后处理组T3~ T5时点的血浆cTnI、Mb和CK-MB质量浓度均较相应时点的对照组显著降低（P<0.05）；七氟醚各处理组间相应时点的血浆cTnI、Mb和CK-MB质量浓度比较差异无统计学意义（P>0.05）。结论 七氟醚预处理和后处理均能减轻婴幼儿先天性心脏病手术中体外循环心肌再灌注损伤的程度，但两者合用并无明显的协同效应。

关键词: 体外循环, 心肌再灌注损伤, 心肌损伤标志物, 七氟醚, 预处理, 后处理, 婴幼儿

Abstract:

Objective To investigate the effects of sevoflurane preconditioning and postconditioning on myocardial reperfusion injury under cardiopulmonary bypass in infants undergoing surgery for congenital heart disease. Methods Sixty children undergoing surgery for ventricular septal defect were randomly divided into control group (no inhalation anesthetics during the surgery), preconditioning group (inhalation of 1.5 MAC sevoflurane for 20 min before aortic cross clamping), postconditioning group (inhalation of 1.5 MAC sevoflurane for 20 min after aortic cross unclamping) and preconditioning+postconditioning group (inhalation of 1.5 MAC sevoflurane for 20 min before and after aortic cross clamping respectively), with 15 patients in each group. The time of aortic cross clamping, time of cardiopulmonary bypass, time of operation, time of mechanical ventilation, duration of stay in cardiac intensive care unit (CICU) and duration of hospital stay were recorded and compared. The mass concentrations of myocardial injury markers of troponin I (cTn-I), myoglobin (Mb) and creatine kinase isoenzyme (CK-MB) were determined after anesthesia induction (T0), before cardiopulmonary bypass (T1), at the end of cardiopulmonary bypass (T2), and 1 h, 6 h, 12 h and 24 h after cardiopulmonary bypass (T3, T4, T5 and T6 respectively). Results There was no significant difference in time of aortic cross clamping, time of cardiopulmonary bypass, time of operation, time of mechanical ventilation, duration of stay in CICU and duration of hospital stay among groups (P>0.05). The plasma mass concentrations of cTnⅠ, Mb and CK-MB at the time points of T2 to T6 were significantly higher than those at the time point of T0 in each group. The plasma mass concentrations of cTnⅠ, Mb and CK-MB at the time points of T3 to T5 in preconditioning group, postconditioning group and preconditioning+postconditioning group were significantly lower than those in control group (P<0.05). There was no significant difference in the plasma mass concentrations of cTnⅠ, Mb and CK-MB at each time point among preconditioning group, postconditioning group and preconditioning+postconditioning group (P>0.05). Conclusion Both sevoflurane preconditioning and postconditioning can relieve myocardial reperfusion injury under cardiopulmonary bypass in infants undergoing surgery for congenital heart disease, while the combination of them may not bring additional benefit.

Key words: cardiopulmonary bypass, myocardial reperfusion injury, myocardial injury marker, sevoflurane, preconditioning, postconditioning, infants