不同麻醉药物对心脏手术患者心肌氧化损伤的影响

Effects of Different Anesthetics on Myocardial Oxidative Damage in Patients Undergoing Cardiac Surgery

摘要:

〔摘 要〕 目的：分析对心脏手术患者使用不同麻醉药物对其心肌氧化损伤的影响。 方法：选取厦门市中医院 2020 年 1 月至 2021 年 1 月期间进行心脏手术的 90 例患者。采用抽签法将其随机分为 M 组、Q 组、B 组，各 30 例。M 组采用咪 达唑仑麻醉，Q 组采用七氟烷麻醉，B 组采用丙泊酚麻醉，分析各组心肌损伤指标、氧化应激指标。 结果：术前（T0）时 三组患者的心肌肌钙蛋白 I（cTnI）、乳酸脱氢酶（LDH）、磷酸肌酸激酶同工酶（CK–MB）、磷酸肌酸激酶（CK）比 较，差异无统计学意义（P ＞ 0.05）。动脉开放 30 min（T1）、动脉开放 1 h（T2）时三组患者的 cTnI、LDH、CK–MB、 CK 均高于 T0，且 T1、T2 时 Q 组、B 组的 cTnI、LDH、CK–MB、CK 均低于 M 组，差异具有统计学意义（P ＜ 0.05）， T1、T2 时 Q 组、B 组的 cTnI、LDH、CK–MB、CK 比较，差异无统计学意义（P ＞ 0.05）；T0 时三组患者的超氧化物歧 化酶（SOD）、丙二醛（MDA）比较，差异无统计学意义（P ＞ 0.05）。T1、T2 时三组患者的 SOD、MDA 均有显著的变化， 且 T1 时 Q、B 组的 MDA 水平低于 M 组，SOD 显著高于 M 组，差异具有统计学意义（P ＜ 0.05）。T1、T2 时 Q、B 组的 MDA、SOD 比较，差异无统计学意义（P ＞ 0.05）。 结论：对心脏手术患者采用七氟烷或丙泊酚较咪达唑仑麻醉，更能有 效的抑制氧化应激反应，减少患者心肌损伤。

Abstract:

〔Abstract〕 Objective To analyze and compare the effects of different anesthetics on myocardial oxidative damage in patients undergoing cardiac surgery. Methods 90 patients who underwent cardiac surgery from January 2020 to January 2021 in Xiamen Hospital of Traditional Chinese Medicine were selected. They were randomly divided into group M, group Q, and group B by lottery, with 30 cases in each group. Group M was anesthetized with midazolam, group Q was anesthetized with sevoflurane, and group B was anesthetized with propofol. The indicators of myocardial injury and oxidative stress in each group were analyzed. Results There was no significant difference in cardiac troponin I (cTnI), lactate dehydrogenase (LDH), phosphocreatine kinase isoenzyme (CK-MB), and creatine phosphate kinase (CK) among the three groups of patients before operation (T0) (P > 0.05). The cTnI, LDH, CK-MB and CK of the three groups of patients at T1 and T2 were all higher than T0, and the cTnI, LDH, CK-MB and CK of the Q group and B group at T1 and T2 were all lower than those of the M group (P < 0.05). There was no statistically significant difference in cTnI, LDH, CK-MB, CK in group Q and group B at T1 and T2 (P > 0.05); There was no statistically significant difference between superoxide dismutase (SOD) and malondialdehyde (MDA) among the three groups at T0 (P > 0.05). The SOD and MDA of the three groups of patients at T1 and T2 had significant changes. At T1, the MDA levels of Q and B groups were lower than those of M group, and SOD was significantly higher than that of M group. The difference was statistically significant (P < 0.05). There was no significant difference in MDA and SOD between Q and B groups at T1 and T2 (P > 0.05). Conclusion Compared with midazolam, sevoflurane or propofol anesthesia for cardiac surgery patients can effectively inhibit oxidative stress and reduce myocardial damage.