七氟烷预处理对CPB下行心脏瓣膜手术患者血浆NT-proBNP浓度的影响

发布时间：2018-06-17 01:34

本文选题：七氟烷 + 预处理　；参考：《广西医科大学》2014年硕士论文

【摘要】：目的：通过观测患者围体外循环期血浆NT-proBNP浓度变化，了解术后心功能情况，探讨七氟醚预处理对心脏瓣膜置换手术患者的心肌保护作用。方法：2013年9月至2013年12月期间在广西医科大学第一附属医院择期行体外循环心脏瓣膜置换手术患者，从中选取符合研究条件的病例共60例，随机排表法分为两组：对照组(C组)和实验组（S组），各30例。所有患者予以咪达唑仑0.1～0.2mg/kg、维库溴铵0.1～0.15mg/kg及芬太尼10μg/kg麻醉诱导，诱导后气管插管行机械通气。S组在诱导后吸入七氟醚镇静，吸入浓度2％，吸入时间为20min,之后改用咪达唑仑维持麻醉。C组诱导后咪达唑仑维持麻醉。比较两组患者术后机械通气时间、CCU（心脏病监护病房）治疗时间、术后住院时间。于手术前1天（T0）、升主动脉开放20min(T1)、术后6小时（T2）、术后24小时（T3）4个时间点抽取3mL静脉血用于N末端B型利钠肽原（NT-proBNP）检测，同时记录在手术前一天（T0）、术毕(T1′)、术后6小时（T2）、术后24小时（T3）患者的血压（BP）、心率(HR)、中心静脉压（CVP）。观察比较心血管药物使用、主动脉开放后心脏复跳及术后并发症情况等。结果：两组患者术前基本情况、升主动脉阻断时间、体外循环时间、术后机械通气时间、CCU治疗时间、术后住院时间、各时间点观察的生命征和心血管活性药使用等均无统计学差异。组内各时间点NT-proBNP比较：C组中，T2、T3与T0时间点比较，血浆NT-proBNP变化差异有统计学意义（P0.05）；S组，与T0比较，T3明显增高（P0.05）。C组和S组组间比较，T3时间点S组血浆NT-proBNP明显低于C组（P0.05）。两组患者术后并发症的发生无统计学差异，，所有患者均康复出院。结论：CPB下心脏瓣膜手术，患者的血浆NT-proBNP浓度在主动脉开放后逐渐增高；但经七氟烷预处理患者的血浆NT-proBNP浓度明显低于未经七氟烷处理患者的，提示七氟烷具有一定的心肌保护作用。
[Abstract]:Aim: to investigate the myocardial protective effect of sevoflurane preconditioning on cardiac valve replacement by observing the changes of plasma NT-proBNP concentration in patients undergoing cardiopulmonary bypass (CPB). Methods: from September 2013 to December 2013, 60 patients undergoing cardiopulmonary bypass heart valve replacement were selected from the first affiliated Hospital of Guangxi Medical University. Two groups were randomly divided into two groups: control group C (n = 30) and group S (n = 30). All patients were anesthetized with midazolam 0.1 渭 g / kg, vecuronium 0.1~0.15mg/kg and fentanyl 10 渭 g/kg. After induction, the tracheal intubation was administered with mechanical ventilation. Inhalation time was 20 min, then midazolam maintenance anesthesia. C group induced midazolam maintenance anesthesia. The time of postoperative mechanical ventilation (CCU) and postoperative hospitalization time were compared between the two groups. Three mL venous blood samples were collected at 4 time points, one day before operation, 20 mins of ascending aorta and 20 min of T1, 6 hours after operation, 24 hours after operation, and 24 hours after operation. NT-proBNPs of N-terminal B-type natriuretic peptide (NT-proBNPs) were detected. At the same time, the blood pressure, heart rate, central venous pressure and CVP were recorded one day before operation, 6 hours after operation and 24 hours after operation. Cardiovascular drug use, cardiac resuscitation after aortic opening and postoperative complications were observed and compared. Results: the basic condition before operation, the time of ascending aorta occlusion, the time of cardiopulmonary bypass, the time of mechanical ventilation after operation, the time of treatment of CCU, the time of hospitalization after operation, There was no significant difference in life symptoms and use of cardiovascular active drugs at different time points. Comparison of NT-proBNP at different time points in group C, there was a significant difference in plasma NT-proBNP between T0 and T0. Compared with T0, plasma NT-proBNP level in group S was significantly higher than that in group T0. The level of plasma NT-proBNP in group S was significantly lower than that in group C (P 0.05). There was no significant difference in the incidence of postoperative complications between the two groups, and all patients recovered and discharged from hospital. Conclusion the plasma NT-proBNP concentration in patients with valvular valve surgery was increased gradually after aortic opening, but the plasma NT-proBNP concentration in patients pretreated with sevoflurane was significantly lower than that in patients without sevoflurane treatment. The results suggest that sevoflurane has a protective effect on myocardium.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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