芬太尼与瑞芬太尼对心脏瓣膜置换术患者 H - FABP 的影响

目的比较芬太尼和瑞芬太尼对在体外循环下行心脏瓣膜置换术患者心肌的影响。方法体外循环下单瓣瓣膜置换术患者40例，分为芬太尼组（F组）和瑞芬太尼组（R组），每组20例。麻醉诱导2组依次静脉注射咪达唑仑0．05mg·kg-1，依托咪酯0．2mg·kg-1及顺苯磺酸阿曲库铵0．15mg·kg-1，芬太尼10μg·kg-1或R组瑞芬太尼2μg·kg-1。术中2组均持续泵入丙泊酚4～6mg·kg-1·h-1维持镇静，间断静脉推注顺苯磺酸阿曲库铵维持肌松。F组在切皮前、转机前、转机中、停机后，根据血压、心率分别追加芬太尼10～15μg·kg-1；R组持续静脉泵入瑞芬太尼0．2—0．5μg（kg·min）-1，根据血压、心率变化调整输注速度。于麻醉诱导前（哟）、主动脉阻断前即刻（T1）、主动脉开放1h（T2）、主动脉开放3h（13）、主动脉开放6h（T4）、主动脉开放12h（T5）、主动脉开放24h（T6）采动脉血5mL，测血清心型脂肪酸结合蛋白（H—FABP）的浓度。结果2组患者H—FABP蛋白血清浓度在眨、T3、T4及T5时间点均升高，与，IU时间点比较差异有统计学意义（P〈0．05），且T3时间点升高最明显：2组间H—FABP蛋白血清浓度在各时间点比较差异无统计学意义（P〉0．05）。结论体外循环下心脏瓣膜置换手术可引起患者H—FABP血清浓度增高，临床常用剂量芬太尼和瑞芬太尼在心脏瓣膜置换手术中对H—FABP影响是相似的，故两者在缺血再灌注损伤中对心肌的影响有相似的效应。

Effects of fentanyl and remifentanil on the H - FABP in patients undergoing heart valve replacement

Objective To compare the effects of fentanyl and remifentanil on the H - FABP undergoing cardiopulmonary bypass in patients with valve replacement surgery. Methods 40 cases with single valve replacement surgery under cardiopulmonary bypass were selected and randomly divided into two groups （n =20）. Fentanyl group （group F） and remifentanil group （group R）. Anesthesia was induced with in- travenous injection to midazolam 0.05 mg kg-1 , etomidate 0.2 mg kg-1 and cis - atracurium 0. 15 mg kg-1 , group F fentanyl 10 kg-1 or group R remifentanil 2 kg-l. Both groups using continuous infusion of propofol 4 -6 mg kg-1 h-1 maintain sedation by, cis - atracurium was used to maintain muscle relaxation by intravenous infusion. At the following time point： before the skin incision, before the CPB, CPB, after the CPB, group F used fentanyl 10 -15 μg kg-1 by intravenous injection, group R used remifentanil O. 2 - 0.5 μg kg-1 min-1 by continuous intravenous infusion adjust the infusion rate according to blood pressure and heart rate. In both groups respectively collected 5 milliliters artery blood for determination of serum levels of H - FABP activity before induction of anesthesia （T0）, before aortic cross -clamping （T1）, 1 hour after aortic opening （12）, 3 hours after aortic opening （T3）, 6 hours after aortic opening （T4）, 12 hours after aortic opening （TS）, 24 hours after aortic opening （T6）. Results Cardiopulmonary bypass time, operation time, dose of propofol and other narcotic drugs, MAP, HR and CVP were no statistically significant difference with each other （P 〉0.05） ;The serum levels of H - FABP at I2, T3, T4 and T5 were higher between two groups of patients, there were statistically significant differences compared with TO （P 〈 O. 05）, T3 increased more significantly; There were no statistically significant difference with two groups at each time point （ P 〉 O. 05 ）. Conclusion The serum levels of H - FABP is increased after valve replacement surgery in patients during cardiopulmenary bypass. Clinical dose of fentanyl compared with remifentanil can achieve similar effect on the H - FABP and myocardial protection.Objective To compare the effects of fentanyl and remifentanil on the H - FABP undergoing cardiopulmonary bypass in patients with valve replacement surgery. Methods 40 cases with single valve replacement surgery under cardiopulmonary bypass were selected and randomly divided into two groups （n =20）. Fentanyl group （group F） and remifentanil group （group R）. Anesthesia was induced with in- travenous injection to midazolam 0.05 mg kg-1 , etomidate 0.2 mg kg-1 and cis - atracurium 0. 15 mg kg-1 , group F fentanyl 10 kg-1 or group R remifentanil 2 kg-l. Both groups using continuous infusion of propofol 4 -6 mg kg-1 h-1 maintain sedation by, cis - atracurium was used to maintain muscle relaxation by intravenous infusion. At the following time point： before the skin incision, before the CPB, CPB, after the CPB, group F used fentanyl 10 -15 μg kg-1 by intravenous injection, group R used remifentanil O. 2 - 0.5 μg kg-1 min-1 by continuous intravenous infusion adjust the infusion rate according to blood pressure and heart rate. In both groups respectively collected 5 milliliters artery blood for determination of serum levels of H - FABP activity before induction of anesthesia （T0）, before aortic cross -clamping （T1）, 1 hour after aortic opening （12）, 3 hours after aortic opening （T3）, 6 hours after aortic opening （T4）, 12 hours after aortic opening （TS）, 24 hours after aortic opening （T6）. Results Cardiopulmonary bypass time, operation time, dose of propofol and other narcotic drugs, MAP, HR and CVP were no statistically significant difference with each other （P 〉0.05） ;The serum levels of H - FABP at I2, T3, T4 and T5 were higher between two groups of patients, there were statistically significant differences compared with TO （P 〈 O. 05）, T3 increased more significantly; There were no statistically significant difference with two groups at each time point （ P 〉 O. 05 ）. Conclusion The serum levels of H - FABP is increased after valve replacement surgery in patients during cardiopulmenary bypass. Clinical dose of fentanyl compared with remifentanil can achieve similar effect on the H - FABP and myocardial protection.