الملخص
Objective To observe and evaluate the protective effect of desflurane post-conditioning on myocardial injury during cardiopulmonary bypass and its influence on patients'postoperative recovery.Methods A total of 200 patients in need of cardiac surgery were selected as the experimental subjects,who were aged from 20 to 65 years old,and divided into ASA Ⅱ-Ⅲ and NYHA Ⅱ-Ⅲ by endotracheal intubation and extracorporeal circulation method under general anesthesia.The patients were randomly divided into desflurane post-treatment group(experi-mental group,group D)and control group(group C)after selection.With the successive opening of the aorta and superior vena cava,group D were given 5%desflurane by inhalation with mechanical ventilation.While group C inhaled pure oxygen without inhaling desflurane.The depth of intraoperative anesthesia was maintained between 40～50 during the operation.Radial artery blood was collected from patients in 24 h before surgery(T0),immediately after intubation(T1),and 1 h(T2),6 h(T3),12 h(T4)and 24 h(T5)after aortic opening to achieve the determi-nation of troponin I(cTnI)and creatine kinase isoenzyme MB(CK-MB).On the premise of obtaining the informed consent of the patient,about 50 mg of right atrial appendage tissue was collected before aortic intubation(T1.5)and 1 hour after aortic opening(T2)to determine the apoptosis rate.Results(1)cTnI in group C at the time of T2,T3,T4 and T5 was apparently higher than group D(P<0.05).(2)CK-MB in group C at the time of T3 was apparently higher than group D(P<0.05).(3)The myocardial tissue results showed that there was a lower apoptosis rate in experimental group at the time of T2(P<0.05).Conclusion Desflurane post-conditioning has a myocardial protec-tive effect during cardiac surgery under cardiopulmonary bypass.
الملخص
Objective To investigate the effect of desflurane post-processing on the expression of glucose transporter 4 (GIUT4)in myocardial ischemia-reperfusion injury.Methods Twenty-four male New Zealand white rabbits were randomly divided into 4 groups (n =6 each):normal control group (group NC),ischemic-reperfusion group (group IR),ischemic-reperfusion postconditioning group (group IRP),desflurane aftertreatment group (group Des).Myocardial ischemia-reperfusion model was established by ligating the left coronary artery.Plasma glucose,Insulin and myocardial glucose uptake rate were measured at the time point before ischemia (T0),30 min after ischemia (T1),30 min (T2),60 min (T3) and 120 min (T4) after reperfusion,for dynamic comparison;the expression of GLUT4 mRNA in myocardium was detected by quantitative RT-PCR,and GLUT4 protein was detected by Western blot.Results Compared with group NC,the levels of blood glucose at T2-T4 increased in group IR (P＜0.05),but blood glucose in group Des was significantly lower than that in groups IR and IRP at T2-T4 (P＜0.05).Compared with group NC,serum insulin levels in groups IR,IRP and Des were significantly higher at T1-T3 (P＜0.05).The level of serum insulin in groups IRP and Des at T1 and T2 was significantly higher than that in group IR (P＜0.05),while that in group Des was higher than that in group IRP (P＜0.05).Blood glucose uptake rate in group IR at T2-T4 was significantly lower than that in groups NC,IRP and Des (P＜0.05),while the blood glucose uptake rate was higher in group Des than that in group IRP (P＜0.05).compared with group NC,the expression of GLUT4 mRNA and protein in groups IR,IRP and Des decreased (P＜0.05),but compared with groups IR and IRP,GLUT4 mRNA and protein expression increased in group Des (P＜0.05).Conclusion Postconditioning of desflurane can improve myocardial ischemia-reperfusion insulin resistance and increase myocardial glucose uptake,which may be related to the increase of myocardial GLUT4 expression.