The Effect Of Sevoflurane On The Myocardium Of Patients With Extensive Burn Undergoing Early Wound Excision

Background: To compare the influrance of sevofiurane/propofol with remifentanil anesthesia for hemodynamics and myocardial injury markers of myocardial troponin I and creatine kinase in large area burn patients undergoing early wound excision.The exploration of the clinical application and effect of two anesthesia strategies on patients with arge area burn.Method: Eighty patients with extensive burn undergoing early wound excision in our hospital from march 2017 to november 2017 were enrolled,fifty-one males twenty-nine females,aged 20-60 years,weighing 45-80 kg,the total area of burn is51%~70%TBSA,and the area of degree of III degree burns is11~25%TBSA,was hospitalized 24 hours after burns and underwent surgery 3 to 4 days after injuriesthey,were randomly divided into two groups :sevoflurane combined with remifentanil(group S)and propofol combined with remifentanil(group P).Anesthesia maintenance: the S group continued to inhale sevoflurane and maintained the concentration of 0.8 ~ 1.5 MAC.the P group iv pump into propofol 4-6mg/kg/h,the two groups continued infusion of remifentanil 0.1-0.2ug/kg/min,which was maintained by the intermittent infusion of cisatracurium 0.03mg/kg to maintain muscle pine and maintain the BIS 40-60.The remaining anesthesia was the same in both groups.MAP,HR,CO,CI were recorded 5 minutes before escharectomy(T0),5minutes after escharectomy(T1),25 minutes after escharectomy(T2),and 45 minutes after escharectomy(T3).The release solubility of cTnI and CK-MB were measured before anesthesia induction,the end of surgery and 6 h after operation and 24 h after surgery.Adverse cardiovascular event happened,the amount of remifentanil and vasoactive durgs were recorded during perioperation.Result:1.There was no statistically significant difference between the two groups in age,weight,gender,operation time,total area of burn,third-degree burn,input,amount of bleeding and the amount of remifentanil(P>0.05).2.There were no significant differences in hemodynamics and Perioperative cardiovascular events and vasoactive durgs during perioperation(P>0.05).3.There was no significant difference between the two groups of cTnI and CK-MB before anesthesia induction(P>0.05).The release solubility of cTnI and CK-MB were less in the group S than those in the group P at the end of operation and6 h,24h after surgery(P<0.05).Conclution:Sevoflurane combined with remifentanil and propofol combined with remifentanil can maintain hemodynamic stability in large area burn patients undergoing early wound excision.Sevoflurane was more effective in reducing the release of myocardial enzymes and alleviating the myocardial injury in patients with extensive burns,which may had superior protective effect of myocardium to propofol.