[1]张新科,李保林.不同浓度七氟烷全程吸入对行先天性心脏病矫治术患儿心肌的影响[J].新乡医学院学报,2019,36(7):629-633.[doi:10.7683/xxyxyxb.2019.07.007]
　ZHANG Xin-ke,LI Bao-lin.Effect of different concentrations of sevoflurane inhalation on myocardial of children underwent congenital heart disease rectification operation[J].Journal of Xinxiang Medical University,2019,36(7):629-633.[doi:10.7683/xxyxyxb.2019.07.007]
点击复制

不同浓度七氟烷全程吸入对行先天性心脏病矫治术患儿心肌的影响
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
36
期数:
2019年7
页码:
629-633
栏目:
临床研究
出版日期:
2019-07-05

文章信息/Info

Title:
Effect of different concentrations of sevoflurane inhalation on myocardial of children underwent congenital heart disease rectification operation
作者:
张新科1; 李保林2
(1.南阳市中心医院麻醉科,河南　南阳　473000;2.郑州市中心医院麻醉科,河南　郑州　450000)
Author(s):
ZHANG Xin-ke1; LI Bao-lin2
（1.Department of Anesthesiology,Nanyang Central Hospital,Nanyang 473000,Henan Province,China；2.Department of Anesthesiology,Zhengzhou Central Hospital,Zhengzhou 450000,Henan Province,China）
关键词:
七氟烷; 先天性心脏病; 矫治术; 心肌功能
Keywords:
sevoflurane; congenital heart disease; orthopedic surgery; myocardial function
分类号:
R614.2+1
DOI:
10.7683/xxyxyxb.2019.07.007
文献标志码:
A
摘要:
目的　分析不同浓度七氟烷全程吸入对行体外循环（CPB）矫治术的先天性心脏病（CHD）患儿心肌的影响。方法　选择2013年12月至2017年12月南阳市中心医院和郑州市中心医院行择期CPB矫治术的49例CHD患儿为观察对象，根据术中七氟烷浓度将患儿分为A组（n=17）、B组（n=17）、C组（n=15），分别采用体积分数1%、2%、3%七氟烷全程吸入，观察比较3组患儿的体外循环时间、主动脉阻断时间及3组患儿麻醉诱导前、麻醉诱导后、切皮后、劈胸骨后、术毕的平均动脉压（MAP）、心率（HR）；分别于术前（T0）及主动脉开放6 h（T1）、24 h（T2）、48 h（T3）、72 h（T4）采集3组患儿中心静脉血，检测血清心肌肌钙蛋白（cTnI）、肌酸激酶同工酶（CK-MB）水平。结果　3组患儿体外循环时间、主动脉阻断时间比较差异均无统计学意义（F=31.317、14.982，P>0.05）。麻醉诱导前、麻醉诱导后、切皮后、劈胸骨后、术毕时3组患儿的MAP、HR比较差异均无统计学意义（FMAP =43.983、31.968、25.979、12.976、15.321，FHR=51.980、33.981、32.083、10.428、12.984，P>0.05）。3组患儿组内各时间点MAP、HR两两比较差异均无统计学意义（P>0.05），麻醉诱导至术毕时MAP、HR均处于正常范围。3组患儿T0、T4时的cTnI、CK-MB水平比较差异均无统计学意义（FcTnI=0.002、2.428,FCK-MB=0.438、1.091，P>0.05）；3组患儿T1、T2、T3时cTnI、CK-MB水平比较差异均有统计学意义（FcTnI=10.312、5.981、=4.869,FCK-MB=9.981、4.674、2.039，P<0.05）。T1、T2、T3时,C组患儿血清cTnI、CK-MB水平显著低于A组、B组（P<0.05）。3组患儿T1时的cTnI、CK-MB水平与T0时比较均显著增高，T1~T4时cTnI、CK-MB水平呈下降趋势，组内两两比较差异均有统计学意义（P<0.05），T4时的CK-MB水平与T0时比较差异无统计学意义（P>0.05）。结论　体积分数1%、2%、3%七氟烷全程吸入用于小儿先天性心脏病矫治术均不会干扰患儿的血流动力学指标，体积分数3%七氟烷对心肌的保护效果最佳。
Abstract:
Objective　To analyze the effect of different concentrations of sevoflurane on myocardial of children underwent congenital heart disease (CHD) rectification operation.Methods　Forty-nine children with CHD who underwent elective cardiopulmonary bypass (CPB) from December 2013 to December 2017 were selected as study objects.The children were divided into group A (n=17),group B (n=17) and group C (n=15) according to concentration of sevoflurane administered during surgery.The children in group A,B and C were inhaled with volume fraction 1%,2%,and 3% of sevoflurane respectively in whole-course of operation.The time of extracorporeal circulation and aortic occlusion were compared among the three group;the mean arterial pressure（MAP） and heart rate（HR） of children before induction of anesthesia,after induction of anesthesia,after incision,after sternum and after operation were recorded and compared among the three group.Central venous blood of all children was collected before operation（T0）and at 6 h（T1）,24 h（T2）,48 h（T3）,72 h（T4）after aorta opening to detected the levels of cardiac troponin (cTnI) and creatine kinase isoenzyme (CK-MB).Results　There was no significant difference in the time of extracorporeal circulation and aortic occlusion among the three groups (F=31.317,14.982;P>0.05).There was no statistic difference in the MAP and HR before induction of anesthesia,after induction of anesthesia,after incision,after sternum and after operation among the three groups(FMAP=43.983,31.968,25.979,12.976,15.321;FHR=51.980,33.981,32.083,10.428,12.984;P>0.05).There was no statistic difference in the MAP and HR among different time point in the three groups(P>0.05).MAP and HR were in the normal range from anesthesia induction to the end of operative.There was no statistic difference in the levels of cTnI and CK-MB at T0，T4 among the three groups (FcTnI=0.002,2.428;FCK-MB=0.438,1.091;P>0.05).There was statistic difference in the levels of cTnI and CK-MB at time point of T1,T2 and T3(FcTnI=10.312,5.981,4.869;FCK-MB=9.981,4.674,2.039;P<0.05).The serum levels of cTnI,CK-MB of children in group C were significantly lower than those in the group A and group B at time point of T1，T2 and T3 (P<0.05).The serum level of cTnI at time point of T1,T2,T3 and T4 was significantly higher than that at T0 in the three groups (P<0.05);the cTnI level showed a decreasing trend from T1 to T4,and there was statistic difference in each time piont in the three groups (P<0.05).The level of CK-MB at time point of T1,T2,T3 was significantly higher than that at T0(P<0.05),and the level of CK-MB showed a decreasing trend from T1 to T4,and there was statistic difference in each time piont in the three groups (P<0.05);there was no significant difference in the CK-MB level between T4 and T0 in the three groups (P>0.05).Conclusion　The whole-course inhalation of volume fraction 1%,2%,and 3% of sevoflurane dose not interfere with the hemodynamic parameters of children undergo CHD rectification operation.The volume fraction 3% sevoflurane has the best protective effect on myocardium.

参考文献/References:

［1］　陈勤,余丹,游嘉，等.七氟烷预处理对心脏瓣膜置换术患者炎性反应及心肌组织GSK3β、STAT5A表达的影响［J］.第三军医大学学报,2016,38(7):747-752.
［2］　ARAKI R，HAYASHI K,SAWA T.Dopamine D2-receptor antagonist droperidol deepens sevoflurane anesthesia［J］.Anesthesiology,2018,128(4):754-763.
［3］　林立朋,师敬利,张明东，等.七氟烷吸入麻醉对老年冠心病患者围术期血流动力学及心肌的影响［J］.山东医药,2018,58(21):82-84.
［4］　张亮,孙虎,徐志新，等.异丙酚或七氟烷复合瑞芬太尼对大鼠心肌缺血再灌注损伤的影响［J］.医学临床研究,2018,35(6):1069-1071,1075.
［5］　殷亨明,白延仓,王云,等.心脏外科快通道麻醉用于小儿先天性心脏病手术的价值研究［J］.现代中西医结合杂志,2018,27(23):2601-2603.
［6］　叶茂亭,易建光,宋彩萍,等.小儿先天性心脏病介入治疗的麻醉效果评价［J］.基因组学与应用生物学,2018,37(11):5025-5030.
［7］　范智芳,王川,许晓璐,等.瑞芬太尼与芬太尼在小儿先天性心脏病介入手术麻醉中的效果分析［J］.药物评价研究,2017,40(8):1126-1129.
［8］　李渭敏,仲吉英,李艳雪,等.右美托咪定骶管内注射用于小儿先天性心脏病手术镇痛的临床研究［J］.中国医药,2018,13(1):39-43.
［9］　查木哈格,于建设.七氟烷在大鼠心脏再灌注心律失常中的作用及对心肌细胞电生理的影响［J］.中国老年学杂志,2017,37(20):4971-4973.
［10］　张永强,陈胜阳,田建民,等.右美托咪啶对体外循环下瓣膜置换术后患者心肌和肺功能的影响［J］.新乡医学院学报,2017,34(8):712-716.
［11］　丁孟瑶,武勇.七氟烷对体外循环下双瓣膜置换术患者心肌的保护作用［J］.中国体外循环杂志,2018,16(2):96-100.
［12］　乔世刚,孙波,单海华，等.自噬小体清除在七氟烷预处理延迟性心肌保护中的作用［J］.中华急诊医学杂志,2017,26(1):65-70.
［13］　张灿华.七氟烷后处理对体外循环下心脏瓣膜置换术患者心肌酶相关指标的影响［J］.蚌埠医学院学报,2016,41(8):988-991.
［14］　廖俊锋,彭文勇.右美托咪定复合七氟醚在小儿先天性心脏病介入封堵术中的应用［J］.中国临床药学杂志,2018,27(2):106-109.
［15］　YU Q,LI L,LIANG W M.Effect of sevoflurane preconditioning on astrocytic dynamics and neural network formation after cerebral ischemia and reperfusion in rats［J］.Neural Regen Res,2019,14(2):265-271.
［16］　王菲,林多茂,汪晓南,等.小儿先天性心脏病矫治术中机械通气的呼吸管理策略［J］.心肺血管病杂志,2018,37(6):587-589.
［17］　鲁海兵,贾英萍,齐金莲,等.超声引导椎旁神经阻滞在小儿先天性心脏病封堵快通道麻醉中的应用［J］.广东医学,2017,38(3):451-453.
［18］　黄庆,黎必万,陈贤.喉罩复合超快通道麻醉技术在先天性心脏病患儿介入手术中的应用［J］.解放军预防医学杂志,2018,36(4):506-507.
［19］　LAUREN D,ERALDO P S,ANTONIO S,et al.MAC-sparing effect of transdermal fentanyl in sevoflurane-anesthetized sheep［J］.Acta Veterinaria,2018,68(2):211-216.
［20］　覃琴,王琛,乔世刚，等.AMPK信号通路调控的自噬在七氟烷后处理保护大鼠心肌缺血再灌注损伤中的机制研究［J］.生物医学工程研究,2016,35(1):36-40,45.

相似文献/References:

[1]马海燕,杨玉海,孙绍连,等.先天性心脏病单心室一例[J].新乡医学院学报,1993,10(01):026.
[2]乔　刚,胡建国,吴忠仕,等.Glenn 分流术治疗先天性心脏病50 例[J].新乡医学院学报,2006,23(06):611.
[3]解春艳,陈莺,赵振龙,等.七氟烷用于困难气道诱导插管的临床观察[J].新乡医学院学报,2011,28(02):196.
[4]朱耀斌,范祥明,李晓锋,等.改良肺动脉灌注在发绀型先天性心脏病体外循环术中的应用 [J].新乡医学院学报,2012,29(10):762.
[5]丁晓英,韩新生,袁浩峥,等.托烷司琼对七氟烷激活小鼠 5- 羟色胺 3 受体的抑制作用[J].新乡医学院学报,2013,30(03):185.
[6]周子凡１,万居易２,李殿坤１,等. 老年先天性心脏病并发重度肺动脉高压外科手术治疗与保守治疗临床效果比较[J].新乡医学院学报,2015,32(08):774.
[7]王　旭,张加强.右美托咪定联合七氟烷在小儿先天性心脏病微创封堵手术中的应用效果[J].新乡医学院学报,2021,38(5):445.[doi:10.7683/xxyxyxb.2021.05.010]
　WANG Xu,ZHANG Jiaqiang.Application effect of dexmedetomidine combined with sevoflurane for children with congenital heart disease undergoing minimally invasive closure operation[J].Journal of Xinxiang Medical University,2021,38(7):445.[doi:10.7683/xxyxyxb.2021.05.010]
[8]王晓蕾,郭佳庆,常海宽,等.七氟烷后处理对大鼠心肌缺血再灌注损伤的影响[J].新乡医学院学报,2021,38(11):1006.[doi:10.7683/xxyxyxb.2021.11.002]
　WANG Xiaolei,GUO Jiaqing,CHANG Haikuan,et al.Effect of sevoflurane post-treatment on myocardial ischemia-reperfusion injury of rats[J].Journal of Xinxiang Medical University,2021,38(7):1006.[doi:10.7683/xxyxyxb.2021.11.002]
[9]王志斌,樊开凯,乔晨晖.血浆白细胞介素-18、硫化氢水平对先天性心脏病患儿术后并发急性肺损伤的诊断价值[J].新乡医学院学报,2021,38(4):353.[doi:10.7683/xxyxyxb.2021.04.012]
　WANG Zhibin,FAN Kaikai,QIAO Chenhui.Diagnostic value of plasma interleukin-18 and hydrogen sulfide levels for postoperative acute lung injury in children with congenital heart disease[J].Journal of Xinxiang Medical University,2021,38(7):353.[doi:10.7683/xxyxyxb.2021.04.012]
[10]王鹏高,崔亚洲,陈忠建,等.大动脉调转术治疗婴儿大动脉转位近期疗效观察[J].新乡医学院学报,2020,37(8):729.[doi:10.7683/xxyxyxb.2020.08.006]
　WANG Penggao,CUI Yazhou,CHEN Zhongjian,et al.Short-term effect of arterial switch operation in the treatment of transposition of great arteries in infants[J].Journal of Xinxiang Medical University,2020,37(7):729.[doi:10.7683/xxyxyxb.2020.08.006]

更新日期/Last Update: 2019-07-05