Protective Effects Of Sufentanil Preconditioning On Myocardial Injury Induced By Cardiopulmonary Bypass In Cardiac Valve Replacement Patients

Objective To study the protective effects of sufentanil preconditioning on myocardial ischemia-reperfusion injury induced by cardiopulmonary bypass(CPB) in cardiac valve replacement patients.Methods Forty-five patients scheduled for elective cardiac valve replacement with CPB were randomly divided into three groups (n=15): control group(group A), patients received 3 episodes of 5 min normal saline infusion at 1ml·min-1 at 5 min interval before aorta clamping; low-dose sufentanil preconditioning group(group B)and high-dose sufentanil preconditioning group(group C), patients received 3 episodes of 5 min sufentanil infusion at 0.2,0.4μg·kg-1·min-1 at 5 min interval before aorta clamping respectively. Plasma levels of cardiac troponin I(cTnI) and creatine phosphokinase isoenzyme(CK-MB)were measured before induction of anesthesia(T1﹚, 4 h﹙T2﹚,8 h﹙T3﹚,24h﹙T4﹚and 48h﹙T5﹚after aorta unclamping.Results In group A, plasma levels of cTnI at T2, T3, T4 and T5 were higher than that at T1 (P<0.01), and reach the peak level at T3, then declined at T4. In group B and C plasma level of cTnI at T2, T3, and T4 were higher than that at T1(P<0.05 or 0.01), and reach the peak level at T2, then declined to normal range at T5. Plasma cTnI at T2, T3, T4 and T5 in group B and C were lower than that in group A(P<0.05 or 0.01). Plasma levels of CK-MB at T2, T3, T4 and T5 were higher than that at T1 in three groups(P<0.05 or 0.01). There were no significant differences in plasma levels of CK-MB among three groups at T2, T3, but the values were lower in group B and C than that in group A at T4, T5 (P<0.05 or 0.01). Intubation time, the requirement for inotropics, the volume of wound drainage in first postoperative day and ICU stay time in group B and group C were significant less than that in group A.Conclusions Sufentanil preconditioning can relieve myocardial injury induced by cardiopulmonary bypass in cardiac valve replacement patients.