国际麻醉学与复苏杂志   2012, Issue (8): 0-0
    
采用斑点追踪食道超声观察经冠状动脉灌注舒芬太尼对2型糖尿病患者非体外循环冠脉旁路移植术后早期左心室功能失调的影响术后左室功能失调的影响
鲁显福1()
1.安徽医科大学第一附属医院麻醉科
Effect on the left ventricular dysfunction in coronary artery bypass grafting of type 2 diabetes mellitus underlying sufentanil coronary perfusion against ischemia-reperfusion injury by speckle tracking transesophageal echocardiography
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摘要：

目的　采用经斑点追踪食道超声（speckle tranking transesophageal echocardiography, STTE）记录左室长轴平均收缩峰值应变(averaged global longitudinal peak systolic strain, aGLPS)、观察舒芬太尼后处理对2型糖尿病-心血管病共病患者与单纯心血管病患者行非体外循环冠脉旁路移植(off-pump coronary artery bypass grafting, OPCABG)术后左室功能失调的影响。方法　择期单纯心血管病患者(CVD组)与2型糖尿病-心血管疾病共病患者(T2DM-CVD组)各20例，择期施行OPCABG，术中经冠脉内灌注舒芬太尼(0.2 μg/kg)行缺血心肌后处理（Suf-PostC）；经二维食道超声采集STTE / aGLPS，采用FloTrac/Vigileo及Philips M6多功能监测仪行心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、心脏指数（CI）、每搏量（SV）、左心室射血分数(LVEF)。观察并测算给药后各时间点aGLPS（T0, Suf-PoC0 min; T1, Suf-PoC30 min; T2, Suf-PoC2 h; T3, Suf-PoC4 h; T4, Suf-PoC6 h）。结果　两组患者术前除血糖外一般情况均无统计学差异；但在Suf-PoC2 h以后(冠脉全部复通后, T2~T4期），两组患者LVEF值均较术前明显改善（P < 0.05）；T2DM-CVD组[aGLPST0: (-13.4±2.2)%, aGLPST1: (-17.0±2.4)%, aGLPST2:　(-17.3±3.1)%, aGLPST3:　(-14.6±2.6)%, aGLPST4: (-14.7±1.7)%], CVD组[aGLPST0: (-13.1±2.4)%, aGLPST1: (-16.4±3.1)%, aGLPST2:　(-19.6±3.4)%, aGLPST3:　(-20.3±2.6)%, aGLPST4: (-20.4±1.9)%]，两组患者左心室长轴平均收缩峰值应变aGLPS值在(T2~T4)期行同一时间点下的各组绝对数值相比较差异有统计学意义（P < 0.05）。结论　采用STTE记录aGLPS能够定量监测OPCABG患者术中左心室收缩功能；2型糖尿病削弱舒芬太尼后处理对于心肌缺血/再灌注损伤所起保护效应的临床研究仍需进一步积累资料。
关键词： 斑点追踪食道超声心动图；左室长轴平均收缩峰值应变；非体外循环冠脉旁路移植；阿片类药物后处理；舒芬太尼；2型糖尿病
Abstract:

Objective 　To assess sufentanil postconditioning against ischemia-reperfusion injury whether left ventricular systolic deformation could be estimated by speckle tracking transesophageal echocardiography (STTE) / averaged global longitudinal peak systolic strain (aGLPS) in monitoring and treatment of type 2 diabetes mellitus (T2DM)-cardiovascular disease (CVD) co-morbidity or CVD by off-pump coronary artery bypass grafting (OPCABG). Methods　2D-Speckle Tracking Transesophageal Echocardiography cine-loops for off-line speckle tracking analysis were obtained from 40 patients (Group CVD and Group T2DM-CVD, sufentanil postconditioning against ischemia-reperfusion Injury after coronary artery bypass grafting, n=20). Speckle Tracking TEE / aGLPS Study: The analysis of 2D strain was performed offline, using a semiautomatic tracking of LV. After manually tracking the endocardial border on a 2D image end-systolic frame, the software automatically tracked myocardial motion, creating six equidistant speckle tracking regions of interest for each image at isochronal time points (T0, Suf-PoC0 min; T1, Suf-PoC30 min; T2, Suf-PoC2 h; T3, Suf-PoC4 h; T4, Suf-PoC6 h). Heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), cardiac index (CI), stroke volume (SV), and left ventricular ejection fraction (LVEF) were monitored by FloTrac/Vigileo and Philips M6 Multi-Function Monitor in type of two patients undergoing OPCABG. Results　There are no significant differences in the general characteristics of the two groups except for glucose concentration. But the averaged Global Peak Strain (aGLPS) reduced in Group T2DM-CVD than Group CVD 2 hours after sufentanil postconditioning (T2-T4 after coronary recanalization) in cardiac surgery (P<0.05), which is adaptable for other monitoring of left ventricular systolic function [Group T2DM-CVD: aGLPST0,(-13.4±2.2)%; aGLPST1, (-17.0±2.4)%; aGLPST2, (-17.3±3.1)%; aGLPST3, (-14.6±2.6)%; aGLPST4, (-14.7±1.7)%. Group CVD: [aGLPST0, (-13.1±2.4)%; aGLPST1, (-16.4±3.1)%; aGLPST2, (-19.6±3.4)%; aGLPST3, (-20.3±2.6)%; aGLPST4, (-20.4±1.9)%]. Conclusions　STTE / aGLPS can be regarded to evaluate the global left ventricular systolic function, which is very valuable in monitoring and treatment of OPCABG. Further research is needed to develop the evidence-based clinical practice that T2DM attenuates the effects of cardioprotection by sufentanil postconditioning against ischemia/reperfusion injury.
Key words: Speckle tracking transesophageal echocardiography; Averaged global longitudinal peak systolic strain; Off-pump coronary artery bypass grafting; Opioid-postconditioning; Sufentanil; Type 2 diabetes mellitus