硫酸镁结合pH-stat血气管理在深低温停循环过程中的协同神经保护效应  

Synergic Neuroprotective Effect of Magnesium Sulfate Combined with pH - stat on Deep Hypothermia Circulatory Arrest

作　　者：陆兆辉[1] 张耀东[2] 鲁亚南[1] 王顺民[1] 徐志伟[1] 

机构地区：[1]上海第二医科大学附属上海儿童医学中心心胸外科,上海200127 [2]新乡医学院,河南新乡453003

出　　处：《实用儿科临床杂志》2005年第5期483-485,共3页Journal of Applied Clinical Pediatrics

基　　金：上海市百人计划;上海市科学技术委员会科研计划项目资助(044119627)

摘　　要：目的探讨硫酸镁结合pH-stat血气管理在深低温停循环(DHCA)过程中的神经保护效应。方法幼猪24头体质量(10.2±0.26)kg,雌雄不拘,随机均分为pH—stat组和Alpha—stat组。将两组再随机均分为加硫酸镁组和不加硫酸镁组。建立体外循环,降温至肛温18℃,停循环90 min,再灌注复温。手术过程中监测血压、平均动脉压、血气、肛温、颈内动脉血流量。采用高效液相色谱技术(HPLC)分析颈静脉血兴奋性和抑制性氨基酸水平变化。结果硫酸镁结合pH-stat对血清氨基酸水平影响集中在转流降温阶段,对谷氨酸、天冬氨酸均有明显抑制作用(P均<0.05),在停循环后的复温阶段对谷氨酸的抑制作用并不明显(P<0.01),而对于天冬氨酸和甘氨酸则有一定抑制作用(P>0.05)。两者结合可显著增加颈内动脉血流量(P=0.012)。结论硫酸镁与pH—stat相结合具有一定的神经保护效应,其保护效应主要是通过均匀改变脑血流量,抑制兴奋性氨基酸释放等来实现。Objective To study the neuroprotective effect of pH-stat combined with magnesium sulfate on deep hypothermic circulatory arrest (DHCA). Methods Twenty four young piglets were teamed randomly in two groups: pH-stat group and Alpha-stat group, which were then teamed into two groups with or without magnesium sulfate. Cardiopulmonary bypass (CPB) was constructed routinely, and CPB was arrested for 90 minutes until the rectal temperature reached 18℃. Blood pressure, blood gas parameter, and blood flow of internal carotid artery were monitored during operation. Serum excitant and inhibitory amino acid (EAA and IAA) levels was detected through high performance liquid chromatography (HPLC). Results The interactive effect of pH-stat combined with magnesium sulfate focused on primary stage of cardiopulmonary bypass, which inhibited release of EAA. Conclusions Combination of magnesium sulfate and pH-stat can protect nervous system satisfactorily. Suppressing the release of EAA may be the main mechanisms.

关 键 词：硫酸镁 血气管理 深低温 停循环 神经保护 

分 类 号：R726.5[医药卫生—儿科]