不同浓度七氟烷与丙泊酚对体外循环心脏手术患者心肌保护和脑代谢的影响
Effects of Different Concentrations of Sevoflurane and Propofol on Myocardial Protection and Brain Metabolism in Patients undergoing Cardiopulmonary Bypass Cardiac Surgery
刘全成 1孙硕 1王东伟2
作者信息
- 1. 佳木斯大学临床医学院,黑龙江佳木斯 154002
- 2. 黑龙江省佳木斯大学附属第一医院麻醉科,黑龙江佳木斯 154002
- 折叠
摘要
目的 探讨不同浓度七氟烷与丙泊酚对体外循环心脏手术患者心肌保护和脑代谢的影响.方法 选取2021 年6 月至2022 年12 月于佳木斯市中心医院接受体外循环心脏手术治疗的74 例患者作为研究对象,以奇偶法分组,B组37 例,A组37 例.A组麻醉方案为吸入0.5 MAC七氟烷+丙泊酚血浆靶控,B组麻醉方案为吸入1.0 MAC七氟烷+丙泊酚血浆靶控,比较两组血流动力学指标、心肌指标、炎症因子、脑代谢情况.结果 术前(T0)时刻两组患者平均动脉压(MAP)、心率(HR)、心肌肌钙蛋白Ⅰ(cTnI)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、炎症因子水平、脑氧摄取率(CEO2)、颈静脉球血氧饱和度(SjvO2)水平比较差异无统计学意义(P＞0.05);麻醉诱导后(T1)、切皮后(T2)时刻两组患者MAP、HR水平均有下降趋势,术毕(T3)时刻以上指标有上升趋势,且B组患者T1、T2、T3 时刻MAP、HR水平均低于A组(P＜0.05);T1、T2、T3 时刻两组患者cTnI、CK、CK-MB水平呈上升趋势,且B组患者cTnI、CK、CK-MB水平均低于A组(P＜0.05);B组患者T1、T2、T3 时刻的白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平低于A组(P＜0.05),白细胞介素-10(IL-10)水平高于A组(P＜0.05);B组患者T1、T2、T3 时刻的SjvO2水平高于A组(P＜0.05),CEO2水平低于A组(P＜0.05).结论 在体外循环心脏手术麻醉中应用 1.0 MAC七氟烷+丙泊酚具有显著效果,可稳定血流动力学,改善患者脑氧代谢平衡,减轻心肌损伤程度,有效抑制炎症反应.
Abstract
Objective To explore the effects of different concentrations of sevoflurane and propofol on myocardial protection and brain metabolism in patients undergoing cardiopulmonary bypass cardiac surgery.Methods A total of 74 patients who received cardiopulmonary bypass surgery in Jiamusi Central Hospital from June 2021 to December 2022 were selected as the study objects.They were divided into group B(37 cases)and group A(37 cases)by odd-even method.The anesthesia program of group A was 0.5 MAC sevoflurane + propofol plasma target control,and the anesthesia program of group B was 1.0 MAC sevoflurane + propofol plasma target control.The hemodynamic indexes,myocardial indexes,inflammatory factors and brain metabolism of the two groups were compared.Results There was no significant difference in mean arterial pressure(MAP),heart rate(HR),myocardial troponin Ⅰ(cTnI),creatine kinase(CK),creatine kinase isoenzyme(CK-MB),inflammatory factor levels,brain oxygen uptake rate(CEO2)and jugular glomus blood oxygen saturation(SjvO2)between the two groups before surgery(T0)(P＞0.05);After anesthesia induction(T1)and dermectomy(T2),the levels of MAP and HR in both groups showed A downward trend,and the indexes above the time after surgery(T3)showed an upward trend,and the levels of MAP and HR at T1,T2 and T3 in group B were lower than those in group A(P＜0.05).At T1,T2 and T3,the levels of cTnI,CK and CK-MB in two groups had an increasing trend and the levels of cTnI,CK and CK-MB in group B were lower than those in group A(P＜0.05).At T1,T2 and T3,The levels of interleukin-8(IL-8)and tumor necrosis factor-α(TNF-α)in group B were lower than those in group A(P＜0.05),and the levels of interleukin-10(IL-10)were higher than those in group A(P＜0.05).At T1,T2 and T3 SjvO2 level in group B was higher than that in group A(P＜0.05),and CEO2 level was lower than that in group A(P＜0.05).Conclusion The application of 1.0 MAC sevoflurane+propofol in extracorporeal circulation anesthesia for cardiac surgery has a significant effect,making patient hemodynamics more stable.At the same time,it can also reduce the impact on myocardial and brain metabolic indicators,effectively inhibit early inflammatory reactions.
关键词
不同浓度/七氟烷/丙泊酚/体外循环心脏手术/心肌保护/脑代谢Key words
Different concentrations/Heptafluoroalkane/Propofol/Extracorporeal circulation cardiac surgery/Myocardial protection/Cerebral metabolism引用本文复制引用
出版年
2024
国家科技期刊平台
NSTL
万方数据