Effect of sufentanil postconditioning on myocardial ischemia-reperfusion injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass / 中华麻醉学杂志

ABSTRACT

Objective To investigate the effect of sufentanil postconditioning on myocardial ischemiareperfusion (I/R) injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).Methods Sixty ASA Ⅱ or Ⅲ patients ( NYHA Ⅱ or Ⅲ ) of both sexes,aged 19-64 yr,scheduled for cardiac valve rreplacement under CPB,were randomly divided into 4 groups ( n =15 each)control group ( group C),sufentanil 0.5 μg/kg group (group S1 ),sufentanil 1.0 μg/kg group (group S2 ) and sufentanil 2.0 μg/kg group ( group S3 ).In groups S1,S2 and S3,sufentanil 0.5,1.0 and 2.0 μg/kg were infused over 2 min via aortic root 5 min before aortic unclamping respectively.In group C,the equal volume of normal saline (2 ml/kg) was infused instead of sufentanil.Blood samples were taken from the radial artery immediately before induction of anesthesia ( T2 ) and at 2,4,8,24 and 48 h after aortic unclamping ( T1-5 ) for determination of plasma concentrations of cardiac troponin-I (cTnI) and malondialdehyde (MDA) and activities of creatine kinase isoenzyme-MB (CK-MB) and superoxide dismutase (SOD).The duration of CPB,time of aortic clamping,extubation time,duration of stay in ICU,and myocardial contractility score and volume of drainage at 24 h after the operation were recorded.The restoration of spontaneous heart beat and adverse cardiovascular events were observed.Results The plasma cTnI,and MDA concentrations and CK-MB activity were significantly lower,while the SOD activity was significantly higher at T1-3 in group S1 than in group C ( P ＜ 0.05).The plasma cTnl concentration and CK-MB activity were significantly lower at T1-5,the plasma MDA concentration was significantly lower at T1-4,and SOD activity was significantly higher at T1-4,the extubation time and duration of stay in ICU were significantly shorter,and the myocardial contractility score at 24 h after the operation and incidence of adverse cardiovascular events were significantly lower in groups S2,3 than in group C ( P ＜ 0.05),The plasma cTnl concentration and CK-MB activity were significantly lower at T4,5,The plasma MDA concentration was significantly lower at T4,the SOD activity was significantly higher at T3,4,and the myocardial contractility score at 24 h after the operation was significantly lower in groups S2,3 than in group S1 ( P ＜ 0.05).Conclusion Sufentanil postconditioning can relieve myocardial I/R injury in patients undergoing cardiac valve replacement under CPB,and the mechanism is related to inhibition of lipid peroxidation.