發(fā)布時間：2018-06-17 01:34

  本文選題：七氟烷 + 預(yù)處理　； 參考：《廣西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：通過觀測患者圍體外循環(huán)期血漿NT-proBNP濃度變化，了解術(shù)后心功能情況，探討七氟醚預(yù)處理對心臟瓣膜置換手術(shù)患者的心肌保護(hù)作用。 方法：2013年9月至2013年12月期間在廣西醫(yī)科大學(xué)第一附屬醫(yī)院擇期行體外循環(huán)心臟瓣膜置換手術(shù)患者，從中選取符合研究條件的病例共60例，隨機(jī)排表法分為兩組：對照組(C組)和實驗組（S組），各30例。所有患者予以咪達(dá)唑侖0.1～0.2mg/kg、維庫溴銨0.1～0.15mg/kg及芬太尼10μg/kg麻醉誘導(dǎo)，誘導(dǎo)后氣管插管行機(jī)械通氣。S組在誘導(dǎo)后吸入七氟醚鎮(zhèn)靜，吸入濃度2％，吸入時間為20min,之后改用咪達(dá)唑侖維持麻醉。C組誘導(dǎo)后咪達(dá)唑侖維持麻醉。比較兩組患者術(shù)后機(jī)械通氣時間、CCU（心臟病監(jiān)護(hù)病房）治療時間、術(shù)后住院時間。于手術(shù)前1天（T0）、升主動脈開放20min(T1)、術(shù)后6小時（T2）、術(shù)后24小時（T3）4個時間點抽取3mL靜脈血用于N末端B型利鈉肽原（NT-proBNP）檢測，同時記錄在手術(shù)前一天（T0）、術(shù)畢(T1′)、術(shù)后6小時（T2）、術(shù)后24小時（T3）患者的血壓（BP）、心率(HR)、中心靜脈壓（CVP）。觀察比較心血管藥物使用、主動脈開放后心臟復(fù)跳及術(shù)后并發(fā)癥情況等。 結(jié)果：兩組患者術(shù)前基本情況、升主動脈阻斷時間、體外循環(huán)時間、術(shù)后機(jī)械通氣時間、CCU治療時間、術(shù)后住院時間、各時間點觀察的生命征和心血管活性藥使用等均無統(tǒng)計學(xué)差異。組內(nèi)各時間點NT-proBNP比較：C組中，T2、T3與T0時間點比較，血漿NT-proBNP變化差異有統(tǒng)計學(xué)意義（P0.05）；S組，與T0比較，T3明顯增高（P0.05）。C組和S組組間比較，T3時間點S組血漿NT-proBNP明顯低于C組（P0.05）。兩組患者術(shù)后并發(fā)癥的發(fā)生無統(tǒng)計學(xué)差異，，所有患者均康復(fù)出院。 結(jié)論：CPB下心臟瓣膜手術(shù)，患者的血漿NT-proBNP濃度在主動脈開放后逐漸增高；但經(jīng)七氟烷預(yù)處理患者的血漿NT-proBNP濃度明顯低于未經(jīng)七氟烷處理患者的，提示七氟烷具有一定的心肌保護(hù)作用。
[Abstract]:Aim: to investigate the myocardial protective effect of sevoflurane preconditioning on cardiac valve replacement by observing the changes of plasma NT-proBNP concentration in patients undergoing cardiopulmonary bypass (CPB). Methods: from September 2013 to December 2013, 60 patients undergoing cardiopulmonary bypass heart valve replacement were selected from the first affiliated Hospital of Guangxi Medical University. Two groups were randomly divided into two groups: control group C (n = 30) and group S (n = 30). All patients were anesthetized with midazolam 0.1 渭 g / kg, vecuronium 0.1~0.15mg/kg and fentanyl 10 渭 g/kg. After induction, the tracheal intubation was administered with mechanical ventilation. Inhalation time was 20 min, then midazolam maintenance anesthesia. C group induced midazolam maintenance anesthesia. The time of postoperative mechanical ventilation (CCU) and postoperative hospitalization time were compared between the two groups. Three mL venous blood samples were collected at 4 time points, one day before operation, 20 mins of ascending aorta and 20 min of T1, 6 hours after operation, 24 hours after operation, and 24 hours after operation. NT-proBNPs of N-terminal B-type natriuretic peptide (NT-proBNPs) were detected. At the same time, the blood pressure, heart rate, central venous pressure and CVP were recorded one day before operation, 6 hours after operation and 24 hours after operation. Cardiovascular drug use, cardiac resuscitation after aortic opening and postoperative complications were observed and compared. Results: the basic condition before operation, the time of ascending aorta occlusion, the time of cardiopulmonary bypass, the time of mechanical ventilation after operation, the time of treatment of CCU, the time of hospitalization after operation, There was no significant difference in life symptoms and use of cardiovascular active drugs at different time points. Comparison of NT-proBNP at different time points in group C, there was a significant difference in plasma NT-proBNP between T0 and T0. Compared with T0, plasma NT-proBNP level in group S was significantly higher than that in group T0. The level of plasma NT-proBNP in group S was significantly lower than that in group C (P 0.05). There was no significant difference in the incidence of postoperative complications between the two groups, and all patients recovered and discharged from hospital. Conclusion the plasma NT-proBNP concentration in patients with valvular valve surgery was increased gradually after aortic opening, but the plasma NT-proBNP concentration in patients pretreated with sevoflurane was significantly lower than that in patients without sevoflurane treatment. The results suggest that sevoflurane has a protective effect on myocardium.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R614

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 郭常春,黃全躍,夏澍,趙水平;30年來住院心臟病病種的變遷-附13419例住院病歷的分析[J];中國醫(yī)師雜志;2004年S1期

2 \孟旗;曹蘅;;心肌頓抑研究進(jìn)展[J];國外醫(yī)學(xué)(老年醫(yī)學(xué)分冊);2009年04期

3 宮麗榮;余劍波;王曼;劉志學(xué);陳慧榮;張?zhí)m芳;;七氟醚與丙泊酚對冠心病患者行非心臟手術(shù)心肌的影響[J];臨床麻醉學(xué)雜志;2011年05期

4 李勇;魏繼承;周述之;劉玉林;;七氟醚后處理對瓣膜置換術(shù)中血清肌鈣蛋白T及IL-6、IL-8濃度的影響[J];臨床麻醉學(xué)雜志;2011年11期

5 魏揠琴;魏繼承;李士林;周述之;;七氟醚缺血后處理對心臟瓣膜置換術(shù)中血清肌鈣蛋白T和心肌細(xì)胞內(nèi)活性氧簇的影響[J];臨床麻醉學(xué)雜志;2012年04期

6 黃秋蘭;陳序;;七氟醚對心臟缺血再灌注的保護(hù)作用及機(jī)制研究進(jìn)展[J];山東醫(yī)藥;2012年03期

7 孫瑛;朱明;張劍蔚;許文音;白潔;張馬忠;;七氟醚預(yù)處理和后處理對嬰幼兒體外循環(huán)心肌再灌注損傷的影響[J];上海交通大學(xué)學(xué)報(醫(yī)學(xué)版);2011年09期

8 陳根殷;王旭光;楊展;陳淑瓊;;七氟醚對心臟瓣膜置換術(shù)患者心肌酶的影響[J];中華全科醫(yī)學(xué);2009年07期

9 陰大偉;李小鷹;黃體鋼;;綜合性醫(yī)院住院心臟病病種的變遷分析[J];天津醫(yī)藥;2007年07期

10 趙佑君;顧爾偉;朱德浩;李曉紅;陳慶書;李衛(wèi)鵬;;三種全程麻醉方式對二尖瓣瓣膜置換術(shù)患者cTnⅠ和CK-MB的影響[J];中華全科醫(yī)學(xué);2012年10期

本文編號：2029005