比较七氟烷与丙泊酚麻醉对体外循环下心脏瓣膜置换术患者氧化标志物的影响

发布时间：2019-06-03 22:53

【摘要】：目的：在风湿性心脏瓣膜病患者的心脏瓣膜置换术中应用丙泊酚和七氟烷两种麻醉药，，分别单独进行术中的麻醉维持。且维持采用单纯的全凭静脉丙泊酚或全程吸入七氟烷两种方式，来比较两种麻醉药物和麻醉方式对心脏瓣膜置换术患者血清中氧化标志物的影响，以及其对心肌功能的影响。 方法：选择2012年12月至2013年4月期间，在山西医科大学第一附属医院心胸外科的风湿性心脏病（二尖瓣或主动脉瓣、或二尖瓣合并主动脉瓣受累）患者30例，入选病例在心功能分级、肝肾功能、呼吸系统功能、其它系统合并症、年龄范围、性别比例、术前患者的服药史和服药种类方面有严格的筛选要求。将此30例择期在体外循环（CPB）下行瓣膜置换术的患者，随机分为两组：丙泊酚组（P）和七氟烷组（S）。两组患者术前采用相同的麻醉诱导，术中维持到手术结束期间；P组采用持续静脉泵注丙泊酚，S组采用全程吸入七氟烷（转流期间运用膜肺）。两组分别于手术开始前（T1）、升主动脉开放后2h（T2）、升主动脉开放后6h（T3）、升主动脉开放后24h（T4）四个不同时间点从中心静脉导管采集定量静脉血，置于抗凝管中运用离心机离心，抽取定量血清保存于-70℃冰箱。待测病例血清收集好以后，在实验室用化学法测定丙二醛（MDA）浓度和过氧化物歧化酶（SOD）活性（MDA和SOD常联合检测反映氧化损伤程度），用酶联免疫法测定一氧化氮合酶（NOS）的表达。记录所得实验数据值进行统计分析。术中常规监测脑电双频谱指数（BIS）值来控制麻醉深度、监测平均动脉压（MAP）、中心静脉压（CVP）、心率（HR）、脉搏氧饱和度（SPO2）、呼气末二氧化碳分压（PETCO2）。记录术中主动脉阻断时间、自动复跳率、心率失常发生率、电除颤率、临时起搏器使用率。 结果：经SPSS13.0统计软件分析：血清氧化标志物的检测中，P组和S组分别在组内比较；两组中与T1时间点相比T2、T3、T4时间点血清中MDA的浓度明显升高，SOD的活性降低，NOS的表达则明显增高（P＜0.05)。P组和S组的组间比较；S组相比P组在T2、T3时间点MDA的浓度、NOS的表达明显降低，SOD活性则升高（P＜0.05)，而两组在T1与T4时间点无明显差异（P＞0.05)。在血流动力学监测中两组中MAP值在停CPB2h后和术毕均明显降低，HR值明显加快（P＜0.05)，而S组在这两个时间点的MAP值明显高于P组（P＜0.05)，术中所监测指标两组中（P组和S组）差异无统计学意义。 结论：风湿性心脏瓣膜病患者在进行心脏瓣膜置换术时，在心肺转流的过程中，患者血清中有氧化产物形成，且会影响NOS的表达。两种麻醉过程中全程吸入七氟烷麻醉的抗氧化作用比全凭静脉丙泊酚麻醉的作用要强，且七氟烷对一氧化氮合酶的影响作用比丙泊酚强，对心脏功能恢复的影响要强于丙泊酚。
[Abstract]:Objective: to maintain intraoperative anesthesia with propofol and sevoflurane in patients with rheumatic valvular heart disease. To compare the effects of two anesthetics and anesthetic methods on serum oxidation markers and myocardial function in patients undergoing cardiac valve replacement, the effects of propofol or sevoflurane inhalation on serum oxidation markers and myocardial function were compared. Methods: from December 2012 to April 2013, 30 patients with rheumatic heart disease (mitral or aortic valve, or mitral valve complicated with aortic valve involvement) in the first affiliated Hospital of Shanxi Medical University were selected. The selected patients had strict screening requirements in cardiac function classification, liver and kidney function, respiratory system function, other system complications, age range, sex ratio, preoperative drug history and drug type. The 30 patients undergoing valve replacement under cardiopulmonary bypass (CPB) were randomly divided into two groups: propofol group (P) and sevofluoroalkane group (S). The patients in the two groups were treated with the same anesthesia induction before operation and maintained until the end of the operation, group P was treated with continuous intravenous infusion of propofol, and group S was treated with sevoflurane inhalation (membrane lung during bypass). Quantitative venous blood samples were collected from central venous catheters at four different time points before operation (T1), 2 hours after ascending aortic opening (T2), 6 hours after ascending aortic opening (T3) and 24 hours after ascending aortic opening (T3). The centrifuge was used in the anticoagulant tube, and the quantitative serum was extracted and stored in the refrigerator at-70 鈩

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