摘要
目的评价在心脏直视手术中异氟醚是否具有处理效应及丙泊酚对异氟醚预处理效应的影响。方法将30例择期行心脏直视手术的室间隔缺损(VSD)患者分为三组:异氟醚吸入组(Ⅰ组)、异氟醚吸入加丙泊酚输注组(Ⅱ组)和对照组(Ⅲ组)。分别于麻醉诱导平稳后(T1)、主动脉阻断时(T2)、主动脉阻断开放后30min(T3)采血检测超氧化物歧化酶(SOD)、丙二醛(MDA);分别于T2、T3、再灌注后3h(T4)及12h(T5)采血检测肌酸激酶同功酶(CK-MB)和乳酸脱氢酶(LDH)。结果在T2时,与同期Ⅲ组比较,Ⅰ组SOD活性降低(P<0.05),MDA含量升高(P<0.05),Ⅱ组SOD活性升高(P<0.05)。T3时Ⅰ组SOD活性和MDA含量均低于Ⅱ组和Ⅲ组(P<0.05)。主动脉开放后的各个时点(T3、T4、T5),三组的血清LDH活性和CK-MB活性均较T2时显著升高(P<0.05);Ⅰ组的LDH活性和CK-MB活性在T3、T4、T5时较Ⅱ组和Ⅲ组低(P<0.05)。结论心脏直视手术中缺血前吸入异氟醚对再灌注心肌具有一定保护作用。缺血前吸入异氟醚同时输注丙泊酚可能会减弱异氟醚对心肌的保护作用。
Objective To evaluate whether isoflurane-induced preconditioning is existed and the effects of propofol on isoflurane-induced preconditioning during ventricular septal defect（VSD） surgery. Methods Thirty ASA Ⅰ-Ⅱ children, scheduled for selective VSD surgery, were divided into three groups： isoflurane group（ Ⅰ ） , isoflurane with propofol group（ Ⅱ ） and control group（ Ⅲ ）. The central venous blood samples were collected for the measurements of superoxide dismutase（SOD） and malondialdehyde（MDA） after induction（T1 ）, at the beginning of clamping（T2 ） and 30 min after release of aortic cross-clamp（T3）. Lactic dehydrogenase（LDH） and creatine kinase MB（CK-MB） were measured at T2, T3 , 4h（T4 ） and 12 h （T5） after release of aortic cross-clamp. Results At T2 , compared with group Ⅲ ,the activity of SOD decreased（P〈0.05） and MDA increased in group Ⅰ significantly（P〈0.05） and SOD in group Ⅱ increased（P〈0.05）. At T3,the activity of SOD and the content of MDA in group Ⅰ were lower than those in group Ⅱ and group Ⅲ ,but there was no significant difference between group Ⅱ and group Ⅲ. The LDH and CK-MB activities in all three groups increased significantly（P〈0.05） at T3,T4 and T5 compared with those at T2. The activities of LDH and CK-MB were lower in group Ⅰ than those in group Ⅱ and group Ⅲ at T3 ,T4 and T5 （P〈0.05）.Conclusion Isoflurane preconditioning has a protective effect on myocardial ischemia reperfusion injury. Propofol may reduce the isoflurane preconditioning efficacy when it was given before clamping.
出处
《临床麻醉学杂志》
CAS
CSCD
2005年第8期511-513,共3页
Journal of Clinical Anesthesiology
