Tritapepe L, Landoni G, Guarracino F, Pompei F, Crivellari M, Maselli D, De Luca M, Fochi O, D'Avolio S, Bignami E, Calabrò M G, Zangrillo A
Università degli Studi La Sapienza di Roma, Dipartimento di Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, Pisa, Italy.
Eur J Anaesthesiol. 2007 Apr;24(4):323-31. doi: 10.1017/S0265021506001931. Epub 2006 Dec 8.
To evaluate the effects of total intravenous anaesthesia vs. volatile anaesthesia on cardiac troponin release in coronary artery bypass grafting with cardiopulmonary bypass, we performed a multicentre randomized controlled study to compare postoperative cardiac troponin release in patients receiving two different anaesthesia plans.
We randomly assigned 75 patients to propofol (intravenous anaesthetic) and 75 patients to desflurane (volatile anaesthetic) in addition to an opiate-based anaesthesia for coronary artery bypass grafting. Peak postoperative troponin I release was measured as a marker of myocardial necrosis.
There was a significant (P < 0.001) difference in the postoperative median (25th-75th percentiles) peak of troponin I in patients receiving propofol 5,5 (2,3-9,5) ng dL(-1) when compared to patients receiving desflurane 2,5 (1,1-5,3) ng dL(-1). The median (interquartile) troponin I area under the curve analysis confirmed the results: 68 (30.5-104.8) vs. 36.3 (17.9-86.6) h ng dL(-1) (P = 0.002). Patients receiving volatile anaesthetics had reduced need for postoperative inotropic support (24/75, 32.0% vs. 31/75, 41.3%, P = 0.04), and tends toward a reduction in number of Q-wave myocardial infarction, time on mechanical ventilation, intensive care unit and overall hospital stay.
Myocardial damage measured by cardiac troponin release could be reduced by volatile anaesthetics in coronary artery bypass surgery.
为评估在体外循环冠状动脉搭桥手术中，全静脉麻醉与挥发性麻醉对心肌肌钙蛋白释放的影响，我们开展了一项多中心随机对照研究，比较接受两种不同麻醉方案患者术后心肌肌钙蛋白的释放情况。
我们将75例患者随机分配至丙泊酚组（静脉麻醉剂），75例患者分配至地氟醚组（挥发性麻醉剂），同时两组患者均接受基于阿片类药物的麻醉用于冠状动脉搭桥手术。术后肌钙蛋白I释放峰值作为心肌坏死的标志物进行测量。
接受丙泊酚的患者术后肌钙蛋白I峰值中位数（第25 - 75百分位数）为5.5（2.3 - 9.5）ng dL⁻¹，与接受地氟醚的患者2.5（1.1 - 5.3）ng dL⁻¹相比，差异有统计学意义（P < 0.001）。曲线下面积分析的肌钙蛋白I中位数（四分位间距）证实了该结果：68（30.5 - 104.8）对36.3（17.9 - 86.6）h ng dL⁻¹（P = 0.002）。接受挥发性麻醉剂的患者术后对血管活性药物支持的需求减少（24/75，32.0%对31/75，41.3%，P = 0.04），并且Q波心肌梗死数量、机械通气时间、重症监护病房停留时间及总住院时间有减少趋势。
在冠状动脉搭桥手术中，挥发性麻醉剂可减少通过心肌肌钙蛋白释放所衡量的心肌损伤。
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