摘要
目的 观察心脏瓣膜置换手术过程中不同阶段应用等剂量[1 MAC（最低肺泡有效浓度）]的七氟醚对围术期心脏功能的影响,探索七氟醚预处理发挥心肌保护作用的最佳时机与方式.方法 择期行心脏膜置换术患者90例,随机分3组：对照组（C组）、七氟醚预处理组（P组）组和七氟醚全程吸入组（S组）.观察术前（T1）、术毕（T2）、术后4 h（T3）、8h（T4）、24 h（T5）和72 h（T6）共6个时点测定心肌肌钙蛋白I （cTnI）和脑利尿钠肽（BNP）的浓度；记录术后不良事件；对比术前及术后3个月超声心动图.结果 3组患者cTnI水平比较差异有统计学意义（P＜0.01）,而BNP、不良事件及3组间术后超声心动图改变差异无统计学意义（P＞0.05）.结论 1 MAC七氟醚对心脏瓣膜置换术患者心肌具有保护作用,最佳方式为全程吸入；而对心脏结构改变无影响,对预后有一定的影响.
[Abstractl Objective Toobserve the effective of^iMAC sevoflurane on perioprative cardiac func- tion at different stages of cardiac valve replacement, and investigate the best occasion and method to per- form myocardial protection by sevoflurane preconditioning. Methods Ninety patients scheduled for cardiac valve replacement were randomly divided into three groups： control group （group C）, sevoflurane precon- ditioning group （group P）, and sevoflurane group （group S）. The concentration of cTnI and BNP was de- termined on the day before surgery （ Tl ）, the end of surgery （ T2 ）, and 4 h （ T3 ）, 8 h （ T4 ）, 24 h （ T5 ） and 72 h （T6 ） after surgery. Postoperative adverse events were recorded, and the echocardiogram was compared before surgery with 3 months after surgery. Results The concentrations of cTnI among 3 groups showed statistically significant difference （ P 〈0. 01 ）, but there was no significant difference in concentra- tion of BNP, adverse events and echocardiogram among 3 groups （ P 〉 0. 05 ）. Conclusion 1 MAC sevoflurane has the action of myocardial protection for patients undergoing cardiac valve replacement, and the best way is to be inhaled during the whole surgery. It could affect the patients ＇ prognosis but coundn＇ t change the structure of heart.
出处
《中华实验外科杂志》
CAS
CSCD
北大核心
2013年第11期2432-2435,共4页
Chinese Journal of Experimental Surgery
基金
高等学校博士学科点专项科研基金联合资助项目（20126517110005）
关键词
心脏瓣膜置换术
七氟醚
肌钙蛋白
脑利尿钠肽
Cardiac valve replacement
Sevoflurane
Cardiac troponin I
Brain natriureticpeptide
