Effect Of Target-controlled Infusion Of Propofol On Hemodynamics And Myocardial Enzymes In Patients Undergoing Valve Replacement Surgeries

ObjectiveTo analyze the effect of target-controlled infusion of propofol on hemodynamics and myocardial enzymes in patients undergoing valve replacement surgeries.MethodsSixty eldly patients among 43-75 years old scheduled for valve replacement surgeries were selected and randomly divied into two groups, control group (C group) and target-controlled infusion of propofol group (T group), with 30 patients in each group.Patients in T group were under target-controlled infusion of 1% propofol.The initial target plasma concentration of propofol is set at 1.0μg/ml.When the bispectral index (BIS) value is less than 70, intravenous sufentanil 0.8 ug/kg and vecuronium bromide 0.1 mg/kg. When the BIS value is less than 60 and the mean arterial pressure (MAP) reduced20% of the baseline value, endotracheal intubation was performed and then patient was under mechanical ventilation. The target plasma concentration of propofol is set at 3-3.5 μg/ml. Cardiopulmonary bypass (CBP) was performed when the target concentration of propofol was reduced to 1 μg/ml. The target concentration of propofol was manitained at 1.5 μg/ml until the end of surgery. Patients of C group was injected with propofol, with a dose of 1.0 mg/kg within 3 min.The endotracheal intubation process and anesthesia management was the same as T group. After intubation, sevoflurane inhalation was added and the minimum alveolar concentration (MAC) was maintained at 1.3～1.5Intravenous sufentanil and vecuronium bromide was added accordingly in both groups. Before anesthesia induction (To), immediately after anesthesia induction (T1), endotracheal intubation (T2),3 mins after skin incision (T3), and immediately after breast bone incision (T4), heart rate (HR),systolic blood pressure (SBP), diastolic blood pressure (DBP), and MAP was recorded, respectively. Before anesthesia induction (Teo), after tracheal extubation (Te1),6 hours after surgery (Te2),24 hours after surgery (Te3), and 48 hours after surgery (Te4), troponin I (cTn1), Creatine Kinase isoenzyme (CK-MB), Creatine Kinase (Creatine Kinase, CK), lactate dehydrogenase (LDH) was measured, respectively. Postoperative recovery time, cognitive dysfunction, and any adverse reactions were recorded postoperatively.ResultsThe HR at T2, T3, T4 of group T was lower than that of group C(P< 0.05). However, the blood pressure atT1,T2,was higher than that of group C (P< 0.05). There were no significant differences between blood pressure and heart rate at other time points(P> 0.05). The concentration of cTn I at Te1, Te3, Te4 of group T were lower than that of group C; The level of CK-MB) at Te2 was higher than that of group C; The level of CK at Tel was higher than that of group C, while it was lower at Te2, Te3, and Te4. The level of LDH of group T at Te1, Te2, Te3, and Te4 was lower than that of group C (P< 0.05). We found that the recovery time, spontaneous breathing time, and extubation time were shorter than that of group C, respectively(P<0.05). The incidence of posoperative cognitive dysfunction was lower in group T at 24,48, and 72 hours after surgery (P< 0.05). The incidences of adverse reactions of group T is 16.7%, which is significantly lower than that of group C (33.3%) (P<0.05).ConclusionIn patients undergoing valve replacement surgeries,,target controlled infusion of propofol during anesthesiaprovides more stable hemodynamics. In addition, target controlled infusion of propofol can reduce the levels of myocardial enzymes, which shows its myocardial protection effect. Furthermore, target controlled infusion of propofol are with less adverse reactions and reduce the incidence of postoperative cognitive dysfunction.