不同麻醉方法在儿童体外循环心内直视术中的麻醉效果及血浆对肌钙蛋白I含量的影响

摘要

目的：比较不同麻醉方法在儿童体外循环心内直视术中的麻醉效果及对血浆肌钙蛋白 I 含量的影响。方法选择2010年6月至2013年6月先天性心脏病患儿100例，随机分为两组：观察组（n =50）和对照组（n =50）。观察组实施七氟醚吸入麻醉，对照组采用丙泊酚静脉麻醉。观察并记录诱导麻醉前（T1）、体外循环前（T2）、后（T3）、术后2 h（T4）、24 h（T5）五个时间点的心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）。于五个时间点抽取桡动脉血3 ml，用 ELISA 法测定血浆肌钙蛋白 I（cnTI）的浓度。观察并比较两组的麻醉效果及对血浆肌钙蛋白 I 含量。结果两组患儿在 T1、T2、T3、T4、T5五个时间点的心率平均动脉压、中心静脉压比较差异均无统计学意义（均 P ﹥0.05）。观察组患儿在 T1，T2，T3时间段肌钙蛋白 I 含量分别为（0.46±0.16）μg、（0.47±0.16）μg、（0.49±0.16）μg 与对照组患儿的（0.44±0.15）μg、（0.46±0.16）μg、（0.50±0.17）μg，比较差异无统计学意义（均 P ﹥0.05）；观察组患儿在 T4，T5时间段肌钙蛋白 I 含量分别为（0.51±0.17）μg、（0.55±0.16）μg 显著低于对照组的（0.65±0.14）μg、（0.82±0.17）μg（均P <0.05）。结论七氟醚吸入麻醉和丙泊酚静脉麻醉在儿童体外循环心内直视术中的麻醉效果无显著差异，前者具有良好的心肌保护作用，可以在临床上广泛应用。%Objective To compare different methods of anesthesia for open heart surgery and anesthetic effect on plasma levels of troponin I in the children′s open heart operation. Methods In a hospital from June 2010 to June 2013,100 cases of children with congenital heart disease were randomly divided into two groups:observation group(n = 50)and control group(n = 50). The observation group received sevoflurane e-ther inhalation anesthesia. The control group received propofol anesthesia. To observe and compare different methods of anesthesia and anesthetic effects on plasma levels of troponin I. Results The difference of two groups of children at T1,T2,T3,T4,T5 heart rate five time points was not statistically significant(all P ﹥ 0. 05). The difference of two groups of children at T1,T2,T3,T4,T5 and mean arterial pressure of five time points was not statistically significant(all P ﹥ 0. 05). The difference of two groups of children at T1,T2,T3,T4,T5 five time points CVP was not statistically significant(all P ﹥ 0. 05). The troponin I level of children observation group T1,T2,T3 period were(0. 46 ± 0. 16)μg,(0. 47 ± 0. 16)μg,(0. 49 ± 0. 16)and the control group of children μg(0. 44 ± 0. 15)μg,(0. 46 ± 0. 16)μg,(0. 50 ± 0. 17)μg. The difference was not statistically significant(all P ﹥ 0. 05). The troponin I level in children in the observation group T4,T5 time were(0. 51 ± 0. 17)μg,(0. 55 ± 0. 16)μg significantly lower than the control group(0. 65 ± 0. 14)μg,(0. 82 ± 0. 17)μg(all P < 0. 05). Conclusion There was no differ-ence in the children′s open heart in sevoflurane inhalation anesthesia and intravenous anesthesia with propofol anesthesia in open heart surgery. The former has a good myocardial protection. And this method can be widely used in clinical practice.