收稿日期: 2023-06-08
网络出版日期: 2024-04-08
基金资助
湖南省卫生健康委员会科研计划项目(20201979);衡阳市科技计划指导性项目(2019jh010981)
Effect of desflurane post⁃conditioning on myocardial protection in patients undergoing cardiac surgery under cardiopulmonary bypass
Received date: 2023-06-08
Online published: 2024-04-08
目的 旨在观察评价地氟烷后处理对体外循环心脏手术中心肌损伤的保护作用及其对患者术后恢复的影响。 方法 以进行心脏择期手术的患者为研究对象，共200例，均采用全麻气管插管体外循环方法，分为ASA Ⅱ-Ⅲ级与NYHA Ⅱ-Ⅲ级，研究对象年龄分布在20 ~ 65岁之间。患者入选编号后随机分为地氟烷后处理组（D组）以及对照组（C组）。主动脉和上腔静脉开放后，D组随机械通气吸入5%地氟烷，C组吸入纯氧。手术中保持麻醉深度控制在40 ~ 50之间。在术前24 h（T0）、插管后即刻（T1）以及主动脉开放后的1 h（T2）、6 h（T3）、12 h（T4）与24 h（T5）采集桡动脉血，测定肌钙蛋白I（cTnI）以及肌酸激酶同工酶 MB（CK-MB）。在取得患者知情同意的前提下，于主动脉插管前（T1.5）以及主动脉开放后的1 h（T2）采集右心耳组织约50 mg测定细胞凋亡率。 结果 C组的cTnI于T2、T3、T4、T5时刻的水平都要高于D组（P < 0.05）。C组CK-MB在T3水平明显高于D组（P < 0.05）。D组细胞凋亡率于T2时低于C组（P < 0.05）。 结论 地氟烷后处理在体外循环下心脏手术中具有心肌保护作用。
黄湘米 , 陈莹 , 王德明 , 吴昆鹏 . 地氟烷后处理对体外循环下心脏手术患者心肌保护的影响[J]. 实用医学杂志, 2024 , 40(6) : 838 -843 . DOI: 10.3969/j.issn.1006-5725.2024.06.018
Objective To observe and evaluate the protective effect of desflurane post?conditioning on myocardial injury during cardiopulmonary bypass and its influence on patients' postoperative recovery. Methods A total of 200 patients in need of cardiac surgery were selected as the experimental subjects， who were aged from 20 to 65 years old， and divided into ASA Ⅱ-Ⅲ and NYHA Ⅱ-Ⅲ by endotracheal intubation and extracorporeal circulation method under general anesthesia. The patients were randomly divided into desflurane post?treatment group （experimental group， group D） and control group （group C） after selection. With the successive opening of the aorta and superior vena cava， group D were given 5% desflurane by inhalation with mechanical ventilation. While group C inhaled pure oxygen without inhaling desflurane. The depth of intraoperative anesthesia was maintained between 40 ~ 50 during the operation. Radial artery blood was collected from patients in 24 h before surgery （T0）， immediately after intubation （T1）， and 1 h（T2）， 6 h （T3）， 12 h （T4） and 24 h （T5）after aortic opening to achieve the determination of troponin I （cTnI） and creatine kinase isoenzyme MB （CK?MB）.On the premise of obtaining the informed consent of the patient， about 50 mg of right atrial appendage tissue was collected before aortic intubation （T1.5） and 1 hour after aortic opening （T2） to determine the apoptosis rate. Results （1）cTnI in group C at the time of T2， T3， T4 and T5 was apparently higher than group D （P < 0.05）. （2）CK?MB in group C at the time of T3 was apparently higher than group D （P < 0.05）. （3）The myocardial tissue results showed that there was a lower apoptosis rate in experimental group at the time of T2 （P < 0.05）. Conclusion Desflurane post?conditioning has a myocardial protective effect during cardiac surgery under cardiopulmonary bypass.
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