摘要
目的研究全程吸入不同浓度七氟烷对体外循环(cpb)小儿先天性心脏病矫治术患者的心肌保护作用及炎性细胞因子的作用。方法根据七氟烷的吸入浓度,将42例先天性心脏病患儿随机分为3组,1%组(S1组)、2%组(S2组)和3%组(S3组),每组14例。麻醉诱导后行气管插管术,自机械通气开始三组患儿连续分别地吸入1%、2%、3%的七氟烷直到手术结束。在术前(T0)、开放主动脉后6 h(T1)、24 h(T2)、48 h(T3)和72 h(T4)分别采集静脉血,测量血浆肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、白介素-6(IL-6)、白介素-8(IL-8)及细胞粘附因子-1(ICAM-1)的血浆浓度。记录下麻醉诱导以前后、切皮后、开胸骨后和术毕的MAP、HR的变化以及体外循环(CPB)时间和主动脉阻断(ACC)时间。结果三组患儿年龄、性别和体重间比较无显著差异(P>0.05);三组患儿CPB、ACC时长及各时点MAP、HR水平间比较差异无统计学意义(P>0.05);三组患儿术前cTnI、CK-MB和IL-6、IL-8、ICAM-1的血浆浓度均在正常范围内,与T0比较,T1-T4时点三组患儿血浆cTnI和CK-MB水平均明显升高(P<0.05),在T1时点IL-6、IL-8、ICAM-1明显高于切皮前(P<0.05),T2时点IL-6、IL-8显著升高(P<0.05);与S1组、S2组比较,S3组cTnI和CK-MB水平较低,T3时点在统计学上有显著差异(P<0.05);与S1组相比较,S2组T2时点ICAM-1水平明显较低;与S3组比较,S2组T1-T2时点IL-6、IL-8和T1时点ICAM-1水平明显较低(P<0.05)。结论在小儿先天性心脏病矫治术中全程吸入3%七氟烷的心肌保护作用更佳,2%七氟烷的抗炎作用更佳。
Objective To study the effects of sevoflurane entire inhaled with different concentrations on myocardial protections and inflammatory cytokines in pediatric congenital heart disease correction surgery.Methods Forty-two children undergoing cardiopulmonary bypass congenital heart disease correction in our hospital were randomly divided into three groups according to the inhalation concentration of sevoflurane,including 1%group(S1 group),2%group(S2 group)and 3%group(S3 group),14 cases in each group.After anesthesia induction,tracheal intubation was started.From the beginning of mechanical ventilation,children in the three groups continued inhaling 1%,2%and 3%sevoflurane until the end of the operation.The changes of MAP and HR were recorded before and after the anesthesia induction,after the skin cut,sternum cut and at the end of surgery.CPB and ACC time was also recorded at the same time.Central venous blood was extracted before the skin cut(T0)and after the aorta opening 6h(T1),24h(T2),48h(T3),and 72h(T4),plasma concentrations of plasma troponin I(cTnI),creatine kinase isoenzyme-mb(CK-MB),interleukin-6(IL-6),interleukin-8(IL-8),and intercellular adhesion molecule-1(ICAM-1)were measured respectively.Results There were no statistically significant differences in general data such as gender,age and weight among the three groups(P>0.05).There was no significant difference in CPB time,ACC time,MAP and HR in the three groups(P>0.05).Plasma concentrations of cTnI,CK-MB,IL-6,IL-8,and ICAM-1 were all within the normal range before the skin cut.Compared with T0,plasma levels of cTnI and CK-MB were significantly increased at T1-T4(P<0.05),IL-6,IL-8 and ICAM-1 were significantly higher at T1 than those before the skin cut(P<0.05),and IL-6 and IL-8 were significantly increased at T2(P<0.05).Compared with S1 and S2 group,cTnI and CK-MB at T1-T4 were lower in S3 group,and there was statistically significant difference at T3(P<0.05).Compared with S1 group,ICAM-1 at T2 in S2 group was significantly lower.Compared with S3 group,IL-6,IL-8 and ICAM-1 at T1-T2 in S2 group were significantly lower(P<0.05).Conclusion In pediatric congenital heart disease correction surgery,3%sevoflurane has better myocardial protective effect and 2%sevoflurane has better anti-inflammatory effect.
作者
方楚龙
李亚雄
王小燕
汪毅
王钊
万子琳
林黎
周财勤
刘碧
FANG Chu-long;LI Ya-xiong;WANG Xiao-yan;WANG Yi;WANG Zhao;WAN Zi-lin;LIN Li;ZHOU Cai-qin;LIU Bi(Dept.of Cardiovascular Surgery Anesthesiology,Yan'an Hospital Affiliated to Kunming Medical University,Kunming Yunnan 650051,China)
出处
《昆明医科大学学报》
CAS
2020年第9期56-61,共6页
Journal of Kunming Medical University
基金
昆明市卫计委卫生科技人才培养基金资助项目(2016SWRC009)。
关键词
全程吸入
七氟烷
不同浓度
小儿
心肌保护作用
抗炎作用
Entire inhalation
Sevoflurane
Different concentrations
Pediatric
Myocardial protective effect
Anti-inflammatory effect
