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目的比较观察丙泊酚和咪达唑仑对紫绀型先天性心脏病患儿心内直视术的心肌保护作用。方法选择 ASA Ⅰ～Ⅱ级心内直视手术的紫绀型先天性心脏病患儿32例,随机等分为两组,每组16例,丙泊酚复合小剂量芬太尼组(PF 组),咪达唑仑复合小剂量芬太尼组(MF 组)。观察患儿血流动力学变化,脉搏血氧饱和度及体温,记录术后拔管时间及术后 ICU 停留时间;取主动脉阻断后10～20 min(T_2)和主动脉开放后10～20 min(T_3)时的心肌组织,观察心肌血红素加氧酶-1(HO-1)的表达;采集开放静脉通路时(T_0)、主动脉开放后2 h(T_4)、术后24 h(T_5)的静脉血,检测血浆中肌钙蛋白Ⅰ(cTnI)含量。结果 PF 组患儿术后的平均拔管时间和平均 ICU 停留时间较 MF 组短(分别为14.17 h vs 23.65 h,30.17 h vs 49.47 h);两组患儿 T_4时(PF:97 ng/ml±33 ng/ml,MF:138 ng/ml±56 ng/ml)cTnI 的水平均高于 T_0(PF.0.17 ng/ml±0.10 ng/ml,MF:0.62 ng/ml±0.96 ng/ml)和 T_5(PF:23 ng/ml±13 ng/ml,MF:24 ng/ml±6 ng/ml),T_5时 cTnI 的水平高于 T_0,但两组间同时点值比较差异无统计学意义;PF 和 MF 组 T_2时心肌 HO-1表达均低于 T_3(灰度值 PF:182.2±0.8vs 125.6±2.1,MF:193.5±1.4 vs 145.5±7.4),MF 组患儿 T_2、T_3时心肌 HO-1的表达低于 PF 组同时点值。结论丙泊酚和咪达唑仑对紫绀型先天性心脏病患儿体外循环心内直视术心肌有保护作用,丙泊酚在刺激心肌保护性蛋白 HO-1方面优于咪达唑仑。
Objective To compare the myocardial protective effects of propofol and midazolam on open heart surgery in children with cyanotic congenital heart disease. Methods Thirty-two children with congenital heart disease of cyanotic congenital heart disease (ASA Ⅰ ~ Ⅱ) undergoing open heart surgery were randomly divided into two groups (n = 16 each): propofol combined with low dose fentanyl group (PF group) , Midazolam combined with low dose fentanyl group (MF group). The changes of hemodynamics, pulse oximetry and body temperature were observed. The time of postoperative extubation and ICU stay were recorded. After the aorta was occluded for 10-20 min (T 2) and 10 ~ (T_0), 2 h after open aorta (T_4), 24 h after operation (T_3), and the expression of HO-1 in myocardium was detected at 20 min (T_3) (T_5) venous blood, detect the plasma troponin Ⅰ (cTnI) content. Results The mean duration of extubation and mean ICU stay in PF group were shorter than that in MF group (14.17 h vs 23.65 h, 30.17 h vs 49.47 h) respectively. At T 4 (PF: 97 ng / ml) (MF: 0.62 ng / ml ± 0.96 ng / ml) was higher than that of T_0 (PF: 0.17 ng / ml ± 0.10 ng / ml, MF: And T_5 (PF: 23 ng / ml ± 13 ng / ml, MF: 24 ng / ml ± 6 ng / ml). The level of cTnI at T_5 was higher than that at T_0. There was no significant difference between the two groups ; The expression of HO-1 in T 2 and T 3 in PF and MF group was lower than that in T 3 (gray value PF: 182.2 ± 0.8 vs 125.6 ± 2.1, MF: 193.5 ± 1.4 vs 145.5 ± 7.4) The expression of HO-1 was lower than that of PF group. Conclusion Propofol and midazolam have protective effects on cardiopulmonary bypass with open heart surgery in children with cyanotic congenital heart disease. Propofol is superior to midazolam in stimulating myocardial protective protein HO-1.