药物与临床
CHEN Jiangxia;ZHOU Qingshan;YIN Shuzhou;HUANG Weiqing
2006, 25(9): 833-0902.
To compare the effect between propofol and midazolam on inflammatory response of tissue injury and prognosis in children with conqenital heart disease undergoing correction of ventricular septal defect with CPB.MethodsTwentyfour HYHA class ⅠⅡ children with congential heart disease, aged from 1 through 7 years old, undergoing elective open heart surgery, were randomly divided into two groups:group PF in which anesthesia were induced with propofol (200 μg· kg1) combined with fentanyl (5 μg· kg1) and vecuronium (0.15 μg· kg1) and maintained with propofol (150 -200 μg· kg1·min1) combined with low dose fentanyl (0.025-0.075 μg·kg1·min1) infusion, and group MF in which anesthesia was induced with madazolam (1 mg·kg1) combined with fentanyl (5 μg·kg1) and vecuronium (0.15 mg·kg1) and maintained with midazolam (0.5-1 μg·kg1·min1) combined with low dose fentanyl (0.03-0.06 μg·kg1·min1).The patient was premedicated with intramusule morphine 0.1 mg·kg1 and scopolamine 0.01 mg·kg1.Left radial artery and right internal jugular vein were cannulated for MAP and CVP monitoring , and ECG,SPO2, nasopharyngeal and rectal temperature were continuously monitored during anesthesia and operation . The time of tracheal extubation and the period of staying at ICU were recorded . Blood samples were taken before operation (t0),10 min after induction (t1),15 min after clamping aorta t2,15min after releasing aorta clamp(t3),2 hours after releasing aorta clamp(t4), and 24 hours after operation (t5) to observe the changes in cytokines in serum. Myocardial samples were collected at different time spots to observe myocardium morphologic changes ,the expression of NFκB and ICAM1. ResultsThe tracheal extubation time in PF group was significant earlier ,and its mean ICU staying time decreased (P<0.05).The values of NFκB and ICAM1's gray degree in both groups were decreased, but more decreased in MF group, IL6 and IL8 were significantly increased at t3,t4,t5 in both groups(P<0.05) ,but the values of cytokines in PF group were lower than MF group (P<0.05).ConclusionIt is shown that propofol combined with low dose fentanyl can reduce inflammatory response and allow earlier recovery with an effect better than midazolam.