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第43卷第12期 南京医科大学学报(自然科学版)
2023年12月 Journal of Nanjing Medical University(Natural Sciences) ·1719 ·
·临床研究·
吸入氧浓度对非体外循环下冠状动脉搭桥患者心肌损伤的影响
范婧婧,韩晶晶,陈 宇,陈晓东 *
南京医科大学第一附属医院麻醉与围手术期医学科,江苏 南京 210029
[摘 要] 目的:观察术中持续吸入低浓度氧和纯氧对非体外循环下冠状动脉搭桥(off⁃pump coronary artery bypass grafting,
OPCABG)患者心肌损伤的影响,拟探究 OPCABG 患者术中的适宜吸入氧浓度(fraction of inspired oxygen,FiO2 )。 方法:选择
2
OPCABG 患者 100 例,年龄 48~78 岁,体重指数(body mass index,BMI)21.7~33.9 kg/m ,美国麻醉医师协会分级(American soci⁃
ety of anesthesiologists physical status classification system,ASA)Ⅲ~Ⅳ级,采用随机数字表法分为2组:低浓度氧组(L组,n=49)
和纯氧组(H 组,n=51)。常规行丙泊酚、芬太尼联合顺式阿曲库铵麻醉诱导并气管插管机械通气后,调节两组吸入氧浓度
(fraction of inspired oxygen,FiO2 )分别为40%和100%,并维持到手术结束,术中采用容量控制通气模式,潮气量6~8 mL/kg,吸呼
比 1∶2,两组均采用全凭静脉麻醉:持续泵注丙泊酚、右美托咪啶及顺式阿曲库铵,间断推注芬太尼,维持术中脑电双频指数
(bispectral index,BIS)值40~60。分别于术前1 d(T1 )、麻醉诱导后(T2 )、手术结束时(T3 )、术后第1天(T4 )及术后第3天(T5 )采患
者上肢静脉血样,测定血清肌酸激酶同工酶(creatine kinase⁃MB,CK⁃MB)及血清脑利钠肽前体(pro brain natriuretic peptide,
proBNP)的浓度,并于各时间点行经胸心脏超声(transthoracic echocardiography,TTE)或经食道心脏超声(transesophageal echo⁃
cardiography,TEE)检查,采用Simpson法测量患者左室射血分数(left ventricular ejection fraction,LVEF)及心输出量(cardiac out⁃
put,CO),记录术后机械通气时间、ICU住院时间及总住院时间。结果:与T1相比,L组和H组在T3~T5时,血清CK⁃MB浓度升高,在
T2~T5时,血清proBNP浓度升高;与L组相比,H组T3~T5时CK⁃MB浓度升高,T2~T5时proBNP浓度升高(P<0.05);与T1相比,L组和
H组T2时,LVEF值和CO值下降,L组T4~T5时,LVEF值和CO值升高,H组T5时,LVEF值和CO值升高;与L组相比,H组T4~T5时
LVEF值和CO值下降(P<0.05);与L组相比,H组患者机械通气时间延长(P<0.05),两组患者ICU住院时间、总住院时间相比,差
异无统计学意义(P>0.05)。 结论:OPCABG患者术中持续吸入40%浓度氧,有助于减轻术后3 d内心肌损伤并改善左心功能。
[关键词] 非体外循环下冠状动脉搭桥手术;吸入氧浓度;心肌损伤
[中图分类号] R514 [文献标志码] A [文章编号] 1007⁃4368(2023)12⁃1719⁃05
doi:10.7655/NYDXBNS20231216
Effects of inspired oxygen fraction on myocardial injury in patients with off⁃pump coronary
artery bypass grafting
FAN Jingjing,HAN Jingjing,CHEN Yu,CHEN Xiaodong *
Department of Anesthesiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China
[Abstract] Objective:To observe the effects of sustained inhalation of low concentrations of oxygen and pure oxygen on
perioperative myocardial injury in patients undergoing off ⁃ pump coronary artery bypass grafting(OPCABG),it is proposed to
investigate the optimal fraction of inspired oxygen(FiO2 )in patient undergoing OPCABG. Methods:A total of 100 patients with
2
OPCABG that are aged 48 to 78 years,body mass index(BMI)of 21.7 to 33.9 kg/m ,and American society of anesthesiologists
physical status classification system(ASA) grade Ⅲ~Ⅳ were selected. They were divided into 2 groups:low⁃concentration oxygen
group(L group,n=49)and pure oxygen group(H group,n=51)using random number table. After the routine anesthesia induction of
propofol and fentanyl combined with cis⁃atricuronium and mechanical ventilation after endotracheal intubation,the inhaled oxygen
concentrations of the two groups were adjusted to 40% and 100%,respectively,and maintained until the end of the operation. Volume
controlled ventilation mode was used during the operation,with a tidal volume of 6~8 mL/kg and an I/E ratio of 1∶2. Two groups of
patients were given total intravenous anesthesia:continuous infusion of propofol,dexmedetomidine,and cis⁃atriammonium,intermittent
[基金项目] 国家自然科学基金青年项目(81901390);中华国际医学交流基金会项目(Z⁃2018⁃35⁃2101)
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通信作者(Corresponding author),E⁃mail:xiaodongc_xy@aliyun.com