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目的探讨瑞芬太尼预处理对体外循环下冠脉搭桥患者心肌缺血再灌注损伤的影响。方法选择年龄65～75岁、体外循环下行冠脉搭桥患者80例,分为瑞芬太尼组(R组)和对照组(C组),每组40例。麻醉诱导成功后胸骨劈开前R组单次给予瑞芬太尼1.0μg/kg,随后0.4μg/(mg.min)泵注25 min;C组按相同速度输注同样容量的生理盐水。在麻醉诱导前(T0),主动脉阻断15 min(T1),主动脉开放后15 min(T2)、2 h(T3)、6 h(T4)和12 h(T6)测定动脉血肌酸激酶-MB(CK-MB)、缺血修饰白蛋白(IMA)、未结合游离脂肪酸(FFAu)和肌钙蛋白T(cTnT)。记录相关血流动力学指标。结果 R组CK-MB在T3、T4和T5较C组明显降低,cTnT在T2、T3、T4和T5较C组明显降低,两组间IMA和FFAu在T2、T3、T4比较有显著差异,R组术后拔出气管导管时间较C组明显缩短。结论瑞芬太尼预处理可以减轻心肌损伤,有助于早期拔管。
Objective To investigate the effect of remifentanil preconditioning on myocardial ischemia-reperfusion injury in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. Methods A total of 80 patients with coronary artery bypass grafting undergoing cardiopulmonary bypass were enrolled in this study. The patients were divided into remifentanil group (R group) and control group (C group), 40 cases in each group. In group R, remifentanil 1.0μg / kg was given once before sternotomy after induction of anesthesia, followed by parenteral injection of 0.4μg / (mg.min) for 25 minutes. In group C, the same volume of saline was infused at the same speed. Arterial blood creatine was measured before anesthesia induction (T0), aortic blockade at 15 min (T1), aortic opening at 15 min (T2), 2 h (T3), 6 h (T4) and 12 h MB-CK, IMA, unbound FFAu and troponin T (cTnT). Record related hemodynamic indicators. Results The CK-MB in group R was significantly lower than that in group C at T3, T4 and T5, and the levels of cTnT at T2, T3, T4 and T5 were significantly lower than those in group C at T2, T3 and T4. The time of pulling out of the tracheal tube in group R was significantly shorter than that in group C. Conclusion Remifentanil preconditioning can relieve myocardial injury and facilitate early extubation.