Departments of Anesthesiology, The First Affiliated Hospital of Xinjiang, Medical University, Urumqi, China.
Scand Cardiovasc J. 2013 Jun;47(3):175-84. doi: 10.3109/14017431.2012.760749. Epub 2013 Jan 17.
We investigated the myocardial protective effect of sevoflurane in patients receiving off-pump coronary artery bypass grafting (OPCABG) and the role of brain natriuretic peptide (BNP).
Forty-eight patients receiving elective OPCABG were randomly assigned to a control group, and to 0.75 MAC, 1.0 MAC and 1.5 MAC sevoflurane groups. Blood samples were collected and levels of BNP and cardiac troponin I (cTnI) were measured before anesthesia, and immediately, 24, 48 and 72 h after surgery.
Dopamine was necessary to maintain blood pressure in the sevoflurane groups, but not in the control group (p < 0.002). 1.0 MAC sevoflurane significantly decreased post-surgical cTnI levels (p < 0.001). 0.75 MAC had no significant effect, and increasing sevoflurane concentrations to 1.5 MAC caused no further decrease in cTnI concentrations. There was no significant difference in BNP level among the groups (p = 0.227) or between any two groups, although values of BNP showed a significant correlation with cTnI values in control subjects immediately after (r = 0.847) and 24 h after (r = 0.661) surgery.
Our results demonstrated that 1.0 MAC and 1.5 MAC sevoflurane can exert a significant myocardial protective effect. BNP cannot be used to predict the myocardial protective effect of sevoflurane in OPCABG.
研究七氟醚在非体外循环冠状动脉旁路移植术（OPCABG）患者中的心肌保护作用及脑钠肽（BNP）的作用。
48 例行择期 OPCABG 的患者被随机分为对照组和 0.75 MAC、1.0 MAC 和 1.5 MAC 七氟醚组。采集血样，分别于麻醉前、术后即刻、24、48 和 72 h 测量 BNP 和心肌肌钙蛋白 I（cTnI）水平。
七氟醚组需要使用多巴胺维持血压，而对照组则不需要（p<0.002）。1.0 MAC 七氟醚显著降低术后 cTnI 水平（p<0.001）。0.75 MAC 无显著作用，增加七氟醚浓度至 1.5 MAC 也不会进一步降低 cTnI 浓度。各组 BNP 水平无差异（p=0.227），两组间也无差异，尽管对照组术后即刻（r=0.847）和 24 h（r=0.661）时 BNP 值与 cTnI 值呈显著相关。
本研究结果表明，1.0 MAC 和 1.5 MAC 七氟醚可发挥显著的心肌保护作用。BNP 不能用于预测 OPCABG 中七氟醚的心肌保护作用。
