發(fā)布時間：2019-06-03 22:53

【摘要】：目的：在風濕性心臟瓣膜病患者的心臟瓣膜置換術中應用丙泊酚和七氟烷兩種麻醉藥，，分別單獨進行術中的麻醉維持。且維持采用單純的全憑靜脈丙泊酚或全程吸入七氟烷兩種方式，來比較兩種麻醉藥物和麻醉方式對心臟瓣膜置換術患者血清中氧化標志物的影響，以及其對心肌功能的影響。 方法：選擇2012年12月至2013年4月期間，在山西醫(yī)科大學第一附屬醫(yī)院心胸外科的風濕性心臟�。ǘ獍昊蛑鲃用}瓣、或二尖瓣合并主動脈瓣受累）患者30例，入選病例在心功能分級、肝腎功能、呼吸系統(tǒng)功能、其它系統(tǒng)合并癥、年齡范圍、性別比例、術前患者的服藥史和服藥種類方面有嚴格的篩選要求。將此30例擇期在體外循環(huán)（CPB）下行瓣膜置換術的患者，隨機分為兩組：丙泊酚組（P）和七氟烷組（S）。兩組患者術前采用相同的麻醉誘導，術中維持到手術結束期間；P組采用持續(xù)靜脈泵注丙泊酚，S組采用全程吸入七氟烷（轉流期間運用膜肺）。兩組分別于手術開始前（T1）、升主動脈開放后2h（T2）、升主動脈開放后6h（T3）、升主動脈開放后24h（T4）四個不同時間點從中心靜脈導管采集定量靜脈血，置于抗凝管中運用離心機離心，抽取定量血清保存于-70℃冰箱。待測病例血清收集好以后，在實驗室用化學法測定丙二醛（MDA）濃度和過氧化物歧化酶（SOD）活性（MDA和SOD常聯(lián)合檢測反映氧化損傷程度），用酶聯(lián)免疫法測定一氧化氮合酶（NOS）的表達。記錄所得實驗數(shù)據(jù)值進行統(tǒng)計分析。術中常規(guī)監(jiān)測腦電雙頻譜指數(shù)（BIS）值來控制麻醉深度、監(jiān)測平均動脈壓（MAP）、中心靜脈壓（CVP）、心率（HR）、脈搏氧飽和度（SPO2）、呼氣末二氧化碳分壓（PETCO2）。記錄術中主動脈阻斷時間、自動復跳率、心率失常發(fā)生率、電除顫率、臨時起搏器使用率。 結果：經SPSS13.0統(tǒng)計軟件分析：血清氧化標志物的檢測中，P組和S組分別在組內比較；兩組中與T1時間點相比T2、T3、T4時間點血清中MDA的濃度明顯升高，SOD的活性降低，NOS的表達則明顯增高（P＜0.05)。P組和S組的組間比較；S組相比P組在T2、T3時間點MDA的濃度、NOS的表達明顯降低，SOD活性則升高（P＜0.05)，而兩組在T1與T4時間點無明顯差異（P＞0.05)。在血流動力學監(jiān)測中兩組中MAP值在停CPB2h后和術畢均明顯降低，HR值明顯加快（P＜0.05)，而S組在這兩個時間點的MAP值明顯高于P組（P＜0.05)，術中所監(jiān)測指標兩組中（P組和S組）差異無統(tǒng)計學意義。 結論：風濕性心臟瓣膜病患者在進行心臟瓣膜置換術時，在心肺轉流的過程中，患者血清中有氧化產物形成，且會影響NOS的表達。兩種麻醉過程中全程吸入七氟烷麻醉的抗氧化作用比全憑靜脈丙泊酚麻醉的作用要強，且七氟烷對一氧化氮合酶的影響作用比丙泊酚強，對心臟功能恢復的影響要強于丙泊酚。
[Abstract]:Objective: to maintain intraoperative anesthesia with propofol and sevoflurane in patients with rheumatic valvular heart disease. To compare the effects of two anesthetics and anesthetic methods on serum oxidation markers and myocardial function in patients undergoing cardiac valve replacement, the effects of propofol or sevoflurane inhalation on serum oxidation markers and myocardial function were compared. Methods: from December 2012 to April 2013, 30 patients with rheumatic heart disease (mitral or aortic valve, or mitral valve complicated with aortic valve involvement) in the first affiliated Hospital of Shanxi Medical University were selected. The selected patients had strict screening requirements in cardiac function classification, liver and kidney function, respiratory system function, other system complications, age range, sex ratio, preoperative drug history and drug type. The 30 patients undergoing valve replacement under cardiopulmonary bypass (CPB) were randomly divided into two groups: propofol group (P) and sevofluoroalkane group (S). The patients in the two groups were treated with the same anesthesia induction before operation and maintained until the end of the operation, group P was treated with continuous intravenous infusion of propofol, and group S was treated with sevoflurane inhalation (membrane lung during bypass). Quantitative venous blood samples were collected from central venous catheters at four different time points before operation (T1), 2 hours after ascending aortic opening (T2), 6 hours after ascending aortic opening (T3) and 24 hours after ascending aortic opening (T3). The centrifuge was used in the anticoagulant tube, and the quantitative serum was extracted and stored in the refrigerator at-70 鈩

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