摘要
目的研究吗啡后处理对胸腔镜下二尖瓣置换术患者的心肌保护作用及其机制。方法选择择期行胸腔镜下二尖瓣置换术患者50例,随机分成对照组(C组)和吗啡后处理组(M组)。于主动脉开放前3min和开放即刻,C组分别给予舒芬太尼0.05μg/kg,M组分别给予吗啡0.05 mg/kg。检测切皮前、主动脉开放后30 min、3h、6h、24h等5个时间点的心肌钙蛋白I(cTnI)、超氧化物歧化酶(SOD)、丙二醛(MDA)、白细胞介素(IL)-6、IL-10的血清浓度,观察并记录呼吸机应用时间、ICU病房驻留时间、术后住院时间、心脏自动复跳率、多巴胺使用率。结果两组患者的呼吸机使用时间、ICU停留时间、术后住院时间、自动复跳率、多巴胺使用率差别均无统计学意义(P>0.05)。在主动脉开放后各时点,M组cTnI、MDA、IL-6浓度均明显低于C组(P<0.05),M组IL-10浓度明显高于C组(P<0.05)。在主动脉开放后3h、6h M组SOD浓度明显高于C组(P<0.05)。结论对胸腔镜下二尖瓣置换术患者,吗啡后处理有一定的心肌保护作用,其机制可能与减轻氧自由基损伤和抑制炎症反应有关。
Objective To investigate the myocardial protection effects and its mechanism of morphine postconditioning in patients undergoing mitral valve replacement surgery with thoracoscope.Methods Fifty patients scheduled for mitral valve replacement with thoracoscope were randomized into 2 groups:control group(C group),and morphine postconditioning group(M group).Three minutes before and immediately after aortic clamping removal,sufentanil(0.05 ug/kg) was given to patients in C group and morphine(0.05 mg/kg) was given to patients in M group.Plasma concentrations of cardiac troponin I(cTnI),superoxide dismutase(SOD),malondialdehyde(MDA),interleukin-6(IL-6) and interleukin-10(IL-10) were measured before skin incision,0.5 h,3 h,6 h,and 24 h after aortic clamping removal.The rate of spontaneous cardiac rhythm resume,mechanical ventilation time,ICU stay,post-operative hospital stay,dosage of dopamine of all patients were compared.Results There was no statistics difference between the two groups as to mechanical ventilation time,ICU stay,post-operative hospital stay,spontaneous cardiac rhythm recovering rate(P>0.05).The doses of dopamine of M group was significantly higher than that of C group(P<0.05).The serum cTnI,MDA,IL-6 concentrations of M group were significantly lower than that of C group(P<0.05).The serum IL-10 concentrations of M group were significantly higher than that of C group at all the time points measured after aortic clamping removal(P<0.05).3h and 6h after aortic clamping removal,the serum SOD concentrations of M group were significantly higher than that of C groups,respectively(P <0.05).Conclusion Morphine postconditioning has some myocardial protective effect in patients undergoing mitral valve re-placement surgery with thoracoscope,its mechanism may involve reduction of oxygen free radical species and inflammatory responses.
出处
《中国体外循环杂志》
2013年第4期230-234,共5页
Chinese Journal of Extracorporeal Circulation
基金
陕西省科学技术研究发展计划(2013K12-02-08)
关键词
吗啡
后处理
胸腔镜
二尖瓣置换
心肌保护
Morphine
Postconditioning
Thoracoscope
Mitral valve replacement
Myocardial protection
