异氟烷和丙泊酚对体外循环心内直视手术患者围术期脑保护作用的比较研究

中国临床药理学与治疗学 ›› 2009, Vol. 14 ›› Issue (7): 812-817.

异氟烷和丙泊酚对体外循环心内直视手术患者围术期脑保护作用的比较研究

郭建荣¹, 贾东林², 任利远¹, 杜金满¹, 陈小非¹, 胡礼宏¹

¹宁波大学医学院附属李惠利医院麻醉科, 宁波315040, 浙江;
²北京大学第三医院麻醉科, 北京100083

收稿日期:2009-06-18 修回日期:2009-07-30 出版日期:2009-07-26 发布日期:2020-10-30
作者简介:郭建荣, 男, 博士后, 教授, 主任医师, 硕士生导师, 研究方向:围术期重要器官功能的保护。Tel:0574-87018725 　E-mail:guomzk@yahoo.com.cn
基金资助:
宁波市医学科技基金项目(2004001)

Protective effects of propofol and isoflurane on cerebral oxygen metabolism and cerebral injury during cardiopulmonary bypass:A comparative study

GUO Jian-rong¹, JIA Dong-lin², REN Li-yuan¹, DU Jian-man¹, CHEN Xiao-fei¹, HU Li-hong¹

¹Department of Anesthesiology, Lihuili Hospital, Medical School, Ningbo University, Ningbo 315040, Zhejiang, China;
²Department of Anesthesiology, the 3rd Hospital of Peking University, Beijing 100083, China

Received:2009-06-18 Revised:2009-07-30 Online:2009-07-26 Published:2020-10-30

摘要/Abstract

摘要： 目的:观察异氟烷和丙泊酚麻醉对体外循环(CPB)心内直视手术患者围术期脑氧供需平衡及脑损伤标记物S100β 和神经元性烯醇化酶(NSE)蛋白浓度的影响。方法:将30 例择期行体外循环瓣膜置换手术病人随机分为异氟烷组和丙泊酚组, 分别于CPB 开始前(T1)、鼻咽温降至稳定期(T2)、复温至36 ℃(T3)、CBP 结束后30 min(T4)、CPB 结束后6 h(T5)和CPB 结束后24 h(T6)抽取桡动脉血和颈静脉球部血检测血气并测定颈内静脉血S100β 和NSE 蛋白的浓度。结果:CPB前两组患者颈内静脉球氧饱和度(SjvO2)、动脉-颈内静脉血氧含量差(Da-jvO2)、氧摄取率(CERO2)、脑损害标记物S100β 及NSE 蛋白浓度差异无统计学意义(P>0.05);随着降温逐渐加深, 两组SjvO2升高, Da-jvO2 和CERO2 降低(P<0.05);复温开始后两组SjvO2 较CPB 前降低, 而Da-jvO2、CERO2则升高(P<0.05);CPB 开始后两组血浆S100β 和NSE 蛋白浓度逐渐升高, 复温期达到峰值;S100β蛋白浓度在停机24 h 后恢复至基础水平,NSE 蛋白浓度仍略高于CPB 前水平;两组各指标比较,丙泊酚组的变化幅度要明显低于异氟烷组。结论:两种麻醉方式均可满足CPB 下瓣膜置换手术的需要, 与异氟烷比较, 丙泊酚麻醉更有利于CPB下患者脑氧代谢的改善和脑损伤的保护。

关键词: 异氟烷, 丙泊酚, 体外循环, 脑氧代谢, 脑损害

Abstract: AIM: To observe the protective effects of isoflurane and propofol by the changes of cerebral oxygen supply-demands balance and serum concentration of S100β and NSE protein in cardiac valve replacement during cardiopulmonary bypass (CPB).METHODS: All of 30 patients undergoing heart valve replacement were prospectively randomized divided into isoflurane group (with isoflurane adoption) and propofol group (with propofol adoption), 15 cases for each group.Jugular venous bulb blood oxygen saturation (SjvO2), Jugular arterial-venous oxygen content difference (Da-jvO2)and cerebral oxygen extraction rate (CERO2)and radical artery blood gas analysis were measured at six stages (T1-T6)of CPB which include before CPB (T1), bring down the temperature to stability stage (T2), recovery temperature to 36 ℃(T3), 30min (T4), 6 hours (T5)and 24 hours (T6)after CPB.In addition, the jugular venous bulb blood was taken at the six time points to measure the blood concentration of S100β and NSE protein.RESULTS: Sjv-O2, Da-jvO2, CERO2 and the blood concentration of S100β and NSE protein which are brain damage markers were no significant difference (P>0.05)in two groups before CPB.SjvO2 in the two groups were both increased during cooling period and then decreased during rewarming period, but the change in propofol group is less than that in the isoflurane group(P<0.01).The blood concentrations of S100β protein and NSE protein were both increased after CPB, the concentration of protein in propofol group, however, were lower than in isoflurane group (P<0.05).CONCLUSION: Two types of anesthesia can be used in valve replacement surgery under CPB.Compared with isoflurane, propofol anesthesia is more conducive to improvement cerebral oxygen metabolism and protection of brain damage in cardiac valve replacement surgery under CPB.

Key words: isoflurane, propofol, cardiopulmonary bypass, cerebral oxygen metabolism, cerebral injury

中图分类号:

R614

郭建荣, 贾东林, 任利远, 杜金满, 陈小非, 胡礼宏. 异氟烷和丙泊酚对体外循环心内直视手术患者围术期脑保护作用的比较研究[J]. 中国临床药理学与治疗学, 2009, 14(7): 812-817.

GUO Jian-rong, JIA Dong-lin, REN Li-yuan, DU Jian-man, CHEN Xiao-fei, HU Li-hong. Protective effects of propofol and isoflurane on cerebral oxygen metabolism and cerebral injury during cardiopulmonary bypass:A comparative study[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2009, 14(7): 812-817.

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