中国体外循环杂志Issue(2)：81-85,5.DOI:10.13498/j.cnki.chin.j.ecc.2015.02.04
吗啡复合七氟烷后处理对胸腔镜下二尖瓣置换术患者的心肌保护作用
Myocardial protective effects of postconditioning with morphine and sevoflurane in patients undergoing mitral valve replacement surgery with thoracoscope
摘要
Abstract
[ Abstract]:Objective To investigate the myocardial protectiveeffects of sevoflurane and morphine postconditioning and its mechanism in patients undergoing mitral valve replacement with thoracoscope. Methods Eighty patients scheduled for mitral valve re⁃placement with thoracoscope were randomized into 4 groups: control group (C), sevoflurane postconditioning group (S), morphine postconditioning group ( M) , morphine and sevoflurane postconditioning group ( MS) . M group was given 0.05 mg/kg morphine 3 mi⁃nutes before and just at the time of arotic clamping removal. S group was treated with 2%sevoflurane 3 minutes before aortic clamping re⁃moval followed with sevoflurane inhalation for 15 minutes after aortic clamping removal. MS group received both sevoflurane and morphine postconditioning according to the method used in S group.and M group. C Group did not receive morphine or sevoflurane. Plasma concen⁃trations of cardiactroponin I ( cTnI) , superoxide dismutase ( SOD) , malondialdehyde ( MDA) , interleukin-6 ( IL-6) , interleukin-10( IL-10) , were measured before skin incision ( T1) , 0.5 h ( T2) , 3 h ( T3) , 6 h ( T4) , and 24 h ( T5) after aortic clamping remov⁃al. The rate of spontaneous cardiac rhythm restoration, mechanical ventilation time, ICU stay, post-operative hospital stay were recor⁃ded and evaluated. Results 1. There was no statistics difference ( P>0.05) among the four groups as to the mechanical ventilation time, ICU stay, and post-operative hospital stay, ( P>0.05) . The spontaneous cardiac rhythm recovering rate of MS group was higher than that of group C ( P<0.05) .2. the changes of Serial myocardial injury index:The serum cTnI concentrations of M group, S group and MS group at all the time points measured after aortic clamping removal were lower than that of C group at the respective time points ( P<0.05) . The serum cTnI concentrations of MS group were lower than that of S group at all the time points measured after aortic clamping removal respectively. Only 3h and 6h after aortic clamping removal, the cTnI concentrations of MS group were lower than that of M group ( P<0.05) . 3. The changes of Oxidation and antioxidation indexes: The serum MDA concentrations of M group, S group and MS group at all the time points measured after aortic clamping removal were lower than that of C group at the respective time points ( P<0.05) . The serum MDA concentrations of MS group were significantly lower than that of S group and M group at all the time points measured after aortic clamping removal respectively ( P<0.05) . At the time points of 3 and 6h after arotic clamping removal, the ser⁃um SOD concentrations of M group and S group were higher than that of C group, respectively ( P<0.05) . The serum SOD concentra⁃tions of At all the time points measured after aortic clamping removal, MS group were significantly higher than that of C group, respec⁃tively. ( P<0.05) . Three, 6 and 24h after aortic clamping removal, the serum SOD concentrations of MS group were significantly high⁃er than that of S and M groups, respectively ( P<0.05) . 4. the changes of Inflammatory and anti-inflammatory index:The serum IL-6 concentrations of M group, S group and MS group at all the time points measured after aortic clamping removal were significantly low⁃er than that of C group at the respective time points ( P<0.05) . The serum IL-6 concentrations of MS group were significantly lower than that of S group and M group at all the time points measured after aortic clamping removal respectively. ( P<0.05) . The serum IL-10 concentrations of M group, S group and MS group at all the time points measured after aortic clamping removal were significantly higher than that of C group at the respective time points ( P<0.05). The serum IL-10 concentrations of MS group were significantly higher than that of S group and M group at all the time points measured after aortic clamping removal respectively. ( P<0.05) . Con⁃clusion The postconditioning with morphine and sevoflurane has a certain myocardial protective effect in patients undergoing mitral valve replacement with thoracoscope, its mechanism may invovle reduction of oxygen free radical species and inflammatory responses.关键词
吗啡/七氟烷/后处理/胸腔镜/二尖瓣置换/心肌保护Key words
Morphine/Sevoflurane/Postconditioning/Thoracoscope/Mitral valve replacement/Myocardial protection引用本文复制引用
冯燕,张霞婧,邵勇平,陈敏,赵静,陈涛,景桂霞..吗啡复合七氟烷后处理对胸腔镜下二尖瓣置换术患者的心肌保护作用[J].中国体外循环杂志,2015,(2):81-85,5.基金项目
陕西省科学技术研究发展计划 （）
