体外循环复温速度对颅内血浆氨基酸、氧自由基及乳酸代谢的影响  

The effect of rewarming rate on amino acid,oxygen-derived free radicals and lactic acid of intracranial venous blood during cardiopulmonary bypass

作　　者：李雯[1] 王祥瑞[1] 

机构地区：[1]上海第二医科大学附属仁济医院麻醉科,200001

出　　处：《临床麻醉学杂志》2004年第7期393-396,共4页Journal of Clinical Anesthesiology

摘　　要：目的　观察复温期复温速度对颅内血浆中氨基酸、氧自由基及乳酸代谢的影响。方法2 1例行冠脉搭桥手术的患者 ,以复温时鼻咽温达到 37℃时间为标准分为 :快速复温组 (A组 ,n =11,t≤ 2 0min) ;缓慢复温组 (B组 ,n =10 ,t >2 0min)。分别于心肺转流 (CPB)前、稳定的低温期、复温10、2 0、30min测定颈内静脉球部血中氨基酸 [谷氨酸 (Glu)、γ 氨基丁酸 (GABA)、甘氨酸 (Gly) ]、氧自由基 [丙二醛 (MDA)、超氧化物歧化酶 (SOD) ]及乳酸 (LAC)含量 ,进行组内与组间比较 ,并计算兴奋性毒性指数 (EI)和静动脉血乳酸含量差 (VADL)。结果　随着温度的升高 ,Glu上升 ,复温 10minA组较B组显著增加 (P <0 .0 1) ;GABA升高B组较A组复温 2 0min时显著 (P <0 0 5 ) ;EI逐渐上升 ,A组较B组上升明显增快 (P <0 0 5 )。A组MDA复温 30min时含量增高 (P <0 0 5 ) ,SOD无显著性改变 ;LAC复温 30min时A组较CPB前明显增多 (P <0 0 5 ) ,但两组比较无显著差异 ,VADL复温 30min时达到高峰 ,A组比B组显著 (P <0 0 5 )。结论　复温过程易造成脑氧供需失衡 ,引起颅内血浆氨基酸代谢紊乱 ,LAC、自由基大量生成 ,复温速度越快 。Objective To explore the effect of the rate of rewarming on disturbance of amino acid, oxygen-derived free radicals and lactic acid(LAC) of intracranial venous blood during cardiopulmonary bypass(CPB).Methods Twenty one patients undergoing CABG were randomly divided into two groups based on the time of nasopharyngeal temperature (NPT) reaching the point of 37℃: the quick rewarming group (group A, n=11,t≤20 min), and slow rewarming group(group B, n=10,t>20 min).The jugular venous blood was obtained before CPB,during the hypothermic period of CPB, and rewarming 10, 20, 30 min. Glutamate(GLU),γ-amino butyric acid and glycine concentration and LAC were measured at the same time points. The excitotoxin index(EI) and the difference of LAC between in artery and in venous(VADL) were calculated. The concentration of malondialdehyde(MDA) and super oxide dismutase(SOD) were estimated and compared between two groups.Results During rewarming period, glutamate and γ-amino butyric acid level increased, and at the time of rewarming 20 min Glu was significantly higher but GABA was lower in group A than those in group B. EI also increased and had a significant difference between groups in rewarming 10 min. MDA in group A increased significantly at the time of rewarming 30 min in both groups. LAC grew up gradually and the significant difference was seen only in group A at rewarming 30 min. The level of VADL achieved peak during stationary in rewarming 30 min,which was more notably in group A.Conclusions Because of disturbing of oxygen supply and demand, metabolism of amino acid of intracranial venous blood was disarranged, with an increase in the concentration of lactic acid and free radicals, indicating that rapidity rewarming could aggravate the toxic effect on the brain.

关 键 词：体外循环 复温 氨基酸代谢 氧自由基代谢 乳酸代谢 脑损害 

分 类 号：R654.1[医药卫生—外科学] R742[医药卫生—临床医学]