【罂粟摘要】体外循环手术中地氟烷和七氟醚通过氧合器后的血药浓度：一项随机、前瞻、先导性研究
体外循环手术中地氟烷和七氟烷通过氧合器后的血药浓度：一项随机、前瞻、先导性研究
贵州医科大学 高鸿教授课题组
翻译：佟睿 编辑：佟睿 审校：曹莹
挥发性麻醉药(VAs)在心血管手术中对心肌细胞具有保护作用。最近的一项体外循环(CPB)手术临床试验报告称：术后1年，使用VAs和全静脉麻醉药的死亡率没有显著差异。然而，术中使用的氧合器其功能可能影响VA的药代动力学。因此，我们测量了使用四种不同微孔聚丙烯中空纤维膜氧合器的患者在体外循环期间的VA血药浓度。
我们将24例择期体外循环患者随机分为两组(地氟醚组和七氟醚组)，然后随机分配到使用四种品牌的氧合器：特鲁莫、利凡诺瓦、美敦力和森科(n=3)。此外，在每个VA组中，随机选择3名患者，并将其分配到另外的人体肺脏组(作为不使用氧和器患者的VA血药浓度)。分别在行6.0 vol%地氟烷和1.7 vol%七氟烷吸入麻醉20min后采集血样，用气相色谱法进行分析。评估氧合器相关的并发症和术后每种氧合器膜表面的结构变化。
人体肺脏内陆氟烷和七氟烷的平均浓度(标准差)分别为182.4(23.2)μg/ml和54.0(9.6)μg/ml，与四组氧合器组比较差异无显著性(P>0.05)。无氧合器相关并发症发生。临床使用后，除了森科产品图像采集困难外，膜纤维没有发生结构变化。
我们的结果表明，在体外循环期间，地氟烷和七氟烷通过氧合器后的血药浓度与人体肺脏对照相似。
Desflurane and sevoflurane concentrations in blood passing through the oxygenator during cardiopulmonary bypass: a randomized prospective pilot study
Purpose Volatile anesthetics (VAs) protect myocardial cells in cardiovascular surgery. A recent clinical trial of cardiopulmonary bypass (CPB) surgery reported no significant difference in mortality rates between the use of VAs and total intravenous anesthetics at 1 year postoperatively. However, oxygenator function may affect the VA pharmacokinetics. Thus, we measured the VA blood concentrations during CPB in patients managed with four different microporous polypropylene hollow fiber membrane oxygenators.
Methods Twenty-four patients scheduled for elective CPB were randomly allocated to one of the two VA groups (desflurane and sevoflurane groups) and, then, randomly divided into one of four oxygenator groups: Terumo, LivaNova, Medtronic, and Senko (n = 3). Additionally, in each VA group, three patients were randomly selected and redundantly allocated to the human lung group (for control blood VA concentration without oxygenator). Blood samples collected 20 min after starting 6.0 vol% desflurane or 1.7 vol% sevoflurane were analyzed using gas chromatography. Oxygenator-related complications and structural changes in the membrane surface of each oxygenator after surgery were evaluated.
Results The mean (standard deviation) concentrations of desflurane and sevoflurane in the human lung were 182.4 (23.2) and 54.0 (9.6) μg/ml, respectively; not significantly different from those in the four oxygenator groups. No oxygenator-related complications occurred. Structural changes in membrane fibers did not occur after clinical use, except for difficulty in image acquisition with Senko products.
Conclusion Our results demonstrated that the blood concentrations of desflurane and sevoflurane passing through oxygenators used during CPB were similar to those in the human lung control.