Effects Of Remifentanil And Fentanyl On The CTnI And H-FABP In Patients Undergoing Heart Valve Replacement

Objective To observe the effect of remifentanil and fentanyl on the cTnI and H-FABPduring cardiopulmonary bypass in patients with valve replacement surgery.To evaluate themyocardial effect of clinical doses of remifentanil and fentanyl.Methods40cases with single valve replacement surgery under cardiopulmonarybypass were selected and randomly divided into two groups. Fentanyl group （F group, n=20each） and remifentanil group （R group, n=20each）. Induction of anesthesia: both groupswere followed by intravenous injection to midazolam0.05mg/kg, etomidate0.2mg/kg andcis-atracurium0.15mg/kg, the F group fentanyl10μg/kg, R group remifentanil2μg/kg.Maintance of anesthesia: both groups using propofol4～6mg kg^-1 h^-1maintain sedation bycontinuous infusion, cis-atracurium was used to maintain muscle relaxation by intravenousinfusion. At the following time point: before the skin incision, before the CPB, CPB,after theCPB, F group used fentanyl10～15μg/kg by intravenous injection, R group usedremifentanil0.2⁰.5μg kg^-1 min^-1by continuous intravenous infusion adjust the infusionrate according to blood pressure and heart rate. The mean arterial pressure （MAP） and heartrate （HR） were recorded in entering the room, before intubation,1min after intubation,incision immediately, before CPB, circulatory arrest, the end of surgery. The central venouspressure （CVP） was recorded in entering the room, incision immediately, before CPB,circulatory arrest and the end of surgery. In both groups respectively collected5millilitersartery blood for determination of serum levels of cTnI and H-FABP activity before inductionof anesthesia （T₀）, before aortic cross-clamping （T₁）,1hour after aortic opening （T₂）,3hours after aortic opening （T3）,6hours after aortic opening （T₄）,12hours after aortic opening （T₅）,24hours after aortic opening （T₆）.Results①Cardiopulmonary bypass time, operation time, dose of propofol and othernarcotic drugs, MAP, HR and CVP, there were no statistically significant difference witheach other（P＞0.05）;②The serum levels of cTnI at all time points after aortic opening threehours were higher between two groups of patients, there were statistically significantdifference compared with T₀（P＜0.01）, T₅increased more significantly; There were nostatistically significant difference with two groups at each time point （P＞0.05）.③Theserum levels of H-FABP at T₂、T3、T₄and T₅were higher between two groups of patients,there were statistically significant differences compared with T₀（P＜0.01）,T3increasedmore significantly; There were no statistically significant difference with two groups at eachtime point （P＞0.05）.Conclusion The serum levels of of cTnI and H-FABP increased after valve replacementsurgery in patients during cardiopulmonary bypass. Clinical dose of fentanyl compared withremifentanil can achieve similar hemodynamic effect and effect on the cTnI and H-FABP.