摘要
目的比较全麻及胸段硬膜外阻滞(TEA)复合全麻对心内直视手术患者血浆丙二醛(MDA)浓度、超氧化物歧化酶(SOD)活性的影响。方法ASAⅠ～Ⅱ级先天性心脏病患者20例,随机分为Ⅰ组和Ⅱ组,每组10例。Ⅰ组全麻,Ⅱ组TEA复合全麻。术中连续监测心电图、心率、平均动脉压、中心静脉压、血氧饱和度、呼气末二氧化碳分压、鼻咽温和肛温。分别于诱导后(T0)、体外循环(CPB)转流前(T1)、开放主动脉5 min(T2)、开放主动脉30 min(T3)及体外循环(CPB)停机6 h(T4)、24 h(T5)、48 h(T6)抽取桡动脉血,测血浆MDA浓度及SOD活性。结果与T0比较,Ⅰ组MDA浓度T1即升高(P<0.05),T2～T5升高更明显(P<0.01);Ⅱ组T2～T5明显升高(P<0.01)。但T2～T5Ⅱ组MDA浓度升高的幅度低于Ⅰ组(P<0.01)。T6时点2组均恢复到T0水平。与T0比较,Ⅰ组T2～T4SOD活性逐渐降低(P<0.01),但T5、T6已恢复至T0水平。Ⅱ组T1～T6与T0比较差异均无统计学意义(P>0.05)。T2～T4Ⅱ组SOD活性高于Ⅰ组(P<0.01)。结论TEA复合全麻能降低体内脂质过氧化程度,增加机体清除氧自由基的能力,减轻心肌细胞的损伤,对心肌缺血-再灌注损伤的心肌具有保护作用。
Objective To evaluate the influence of general anesthesia combined with thoracic epidural anesthesia （TEA）on the concentration of malondialdehyde （MDA） and superoxide dismutase （SOD）during myocardial ischemia reperfusion injury caused by open heart surgery. Methods 20 patients were randomly divided into 2 groups： group Ⅰ （ n = 10） and group Ⅱ （ n = 10）. The general anesthesia was conducted for the patients in group Ⅰ, however, TEA combined with general anesthesia was performed for the patients in group Ⅱ. Standard ECG lead Ⅱ , HR, MAP, CVP, SpO2, PETCO2 and the temperature of patients were continuously monitored. Blood samples were taken from artery after induction （ To ）, before cardiopulmonary bypass （ T1 ） , 5min after opening aorta （ T2 ）, 30min （ T3 ）, 6h after termination of cardiopulmonary bypass （ T4 ） , 24h （ T5 ） and 48h （ T6 ） for determination of the concentration of MDA and the activity of SOD. Results As compared with To, MDA concentration gradually increased in the two groups, there was a significant difference at T1 and T2 -T5 in group Ⅰ ; there was a significant difference at T2 - Ts in group Ⅱ （ P 〈 0.01 ）. MDA concentration at T2 - T5 in group Ⅱ was obviously lower than that in group Ⅰ（ P 〈0.01 ）. There was no significant difference between T6 and To in the two groups （ P 〉 0.05 ）. As compared with To, the activity of SOD gradually decreased and there was a significant difference at T2 - T4 in group [ （ P 〈 0.01 ）. The activity of SOD at T5, T6 was returned to the levels of To in group Ⅰ （ P 〉 0.05 ）. At T2 - T4 the activity of SOD in group Ⅱ was obviously higher than that in group Ⅰ （ P 〈 0.01 ）. Conclusion TEA combined with general anesthesia can lessen the degree of lipid peroxidation, increase the ability of eliminating oxygen free radicals, alleviate the injury of myocardial cell, protect the myocardium of MIRI.
出处
《河北医药》
CAS
2009年第11期1298-1300,共3页
Hebei Medical Journal
关键词
麻醉
硬膜外
心肺转流术
心肌再灌注损伤
丙二醛
超氧化物歧化酶
anesthesia, epidural
cardiopulmonary bypass
myocardial reperfusion injury
malondialdehyde
superoxide dismutase
