Yang Xiao-Lin, Wang Dan, Zhang Guo-Yuan, Guo Xiao-Lan
Departments of Anaesthesiology, Affiliated Hospital of North Sichuan Medical College, 63# Wenhua Road, Shunqing District, Nanchong, Sichuan, 637000, People's Republic of China.
Laboratory Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, 637000, People's Republic of China.
BMC Anesthesiol. 2017 Mar 4;17(1):37. doi: 10.1186/s12871-017-0326-2.
This study aimed to compare myocardial protective effects of anaesthesia with intravenous infusion of propofol versus inhalation of sevoflurane in patients undergoing heart valve replacement surgery with cardiopulmonary bypass.
Seventy-six patients undergoing valve replacement with cardiopulmonary bypass were randomly assigned to propofol or sevoflurane anesthesia during the surgery, respectively. For assessing myocardial injury, cardiac troponin I (cTnI) and creatine kinase isozyme (CK-MB) were determined before induction (T), 0.5 h (T) and 3 h (T) after aortic unclamping, and 24 h (T) and 48 h (T) after surgery. The concentrations of interleukin (IL)-6 and IL-10 as the systemic inflammatory and anti-inflammatory markers were also measured at above time points.
In the sevoflurane group, the plasma concentrations of cTnI and CK-MB from T to T and the levels of IL-6 and IL-10 from T to T were lower than those in the propofol group. Moreover, a higher ratio of automatic heart beat recovery and a shorter length of intensive care unit or hospital stay were found in the sevoflurane group comparing with the propofol group.
Sevoflurane anaesthesia produced more prominent myocardial protection and attenuated inflammatory response than propofol anaesthesia in patients with valve replacement surgery under cardiopulmonary bypass, resulting in shorter ICU and in-hospital stay.
Identified as ChiCTR-IOR-16009979 at http://www.chictr.org.cn/ .
本研究旨在比较在接受体外循环心脏瓣膜置换手术的患者中，静脉输注丙泊酚麻醉与吸入七氟醚麻醉对心肌的保护作用。
76例接受体外循环瓣膜置换术的患者在手术期间分别随机分配接受丙泊酚或七氟醚麻醉。为评估心肌损伤，在诱导前（T0）、主动脉阻断后0.5小时（T1）和3小时（T2）以及手术后24小时（T3）和48小时（T4）测定心肌肌钙蛋白I（cTnI）和肌酸激酶同工酶（CK-MB）。还在上述时间点测量作为全身炎症和抗炎标志物的白细胞介素（IL）-6和IL-10的浓度。
在七氟醚组中，从T1到T4的cTnI和CK-MB血浆浓度以及从T1到T4的IL-6和IL-10水平低于丙泊酚组。此外，与丙泊酚组相比，七氟醚组发现自动心跳恢复率更高，重症监护病房或住院时间更短。
在体外循环下进行瓣膜置换手术的患者中，七氟醚麻醉比丙泊酚麻醉产生更显著的心肌保护作用并减轻炎症反应，从而导致重症监护病房和住院时间更短。
