Objective To compare the protective role of sevoflurane and propofol in the function of myocardium and lung in patients undergoing coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB). Methods Fifty-two patients with ASA Ⅱ or Ⅲ and cardiac function scale of Ⅱ or Ⅲ scheduled for CABG under CPB were randomized into sevoflurane group (group S) and propofol group (group P) with 26 cases each. After clamping the aorta, patients in the group S received sevoflurane 0. 5％-3％ through membrane oxygenator, but in the group P, propofol 2-3 g/kg was given with target-controlled infusion. Arterial blood gas was analyzed at the following time points: immediately before the operation, 2, 4 and 8 h after CPB, and the values of alveolararterial oxygen pressure difference (D(A-a)O2), respiratory index (RI) and oxygenation index (OI) were calculated. Creatine phosphokinase-MB (CK-MB) and cardiac troponin I (cTnI) were detected at the immediate time before operation, 6, 12, 24 and 48 h of after operation. The rates of atrial fibrillation, myocardial ischemia and automatic recovery heart, ejection fraction (EF) and duration of mechanical ventilation were recorded. Results Compared with the group P, patients in the group S had lower D(A-a)O2 and RI (P＜0. 05), and OI decreased since 4 h after operation in both groups,but the influence of sevoflurane on OI was smaller than propofol (P＜0. 05). CK-MB and cTnl in the group S were significantly lower than those of group P (P＜0. 01). The rates of atrial fibrillation and myocardial ischemia in group S were less, and the duration of ventilation was shorter (P＜0. 05), and the volume of EF and rate of automatic recovery heart were significantly higher than group P (P＜ 0. 05). Conclusion Sevoflurane. exerts protective role in the function of myocardium and lung in patients undergoing CAGB under CPB.%目的 比较七氟醚与丙泊酚对心肺转流(CPB)冠状动脉旁路移植术(CAEG)患者心肌与肺功能的保护作用.方法 择期CPB下行CABG患者52例,ASAⅡ或Ⅲ级,心功能Ⅱ或Ⅲ级,随机均分为七氟醚组(S组)与丙泊酚组(P组).夹闭主动脉后,S组通过膜肺吹入0.5%～3%七氟醚,P组靶控输注丙泊酚2～3μg/kg.予术前、术后2、4、8 h行血气分析,计算肺泡-动脉氧分压差[D(A-a)O<,2>]、呼吸指数(RI)及氧合指数(OI);予术前、术后6、12、24、48 h检测肌酸激酶同工酶(CK-MB)与肌钙蛋白I(cTnI)水平;记录房颤(Af)发生率、心肌缺血率、射血分数(EF)、自动复跳率及呼吸支持时间.结果 术后各时点S组患者D(A-a)O<,2>与RI明显低于P组(P<0.05);而OI明显高于P组(P<0.05).S组术后CK-MB与cTnl明显低于P组(P<0.01).Af发生率与心肌缺血率明显低于P组,呼吸支持时间明显短于P组(P<0.05),EF值和自动复跳率明显高于P组(P<0.05).结论 CPB下CABG中通过膜肺给予七氟醚对患者心肌与肺功能有一定的保护作用.
展开▼
