脑苷肌肽对心脏手术中脑糖利用和乳酸浓度的影响  

Effects of Cattle Encephalon Glycoside and Ignotin Injection on Cerebral Glucose Metabolism and Lactate Concentration in Patients Undergoing Cardiac Valve Replacement

作　　者：杨大烜[1] 杨静[1] 李立环[1] 

机构地区：[1]中国医学科学院心血管病研究所阜外心血管病医院麻醉科,北京100037

出　　处：《中国体外循环杂志》2007年第4期207-209,共3页Chinese Journal of Extracorporeal Circulation

摘　　要：目的探讨体外循环(extracorporeal circulation,ECC)下心脏瓣膜置换术患者术中脑糖利用和乳酸浓度变化以及脑苷肌肽对其影响。方法40例ECC下行心脏瓣膜置换术患者,随机分为脑苷肌肽组(A组)和对照组(B组),每组各20例。A组于麻醉诱导后静脉注射脑苷肌肽20 ml(每毫升含神经节苷脂50μg、多肽3.2 mg),B组给等容积生理盐水。分别于给药前(T1)、ECC开始降温至鼻咽温33℃(T2)、心肌血运阻断20 min(T3)、ECC复温至鼻咽温33℃(T4)、ECC结束(T5)以及手术结束(T6),测定桡动脉和颈静脉球部血血糖浓度差(G(a-v))以及颈静脉球部乳酸浓度(Lac)。结果两组ECC降温及低温稳定阶段(T2和T3)G(a-v)显著低于基础值T1(P<0.05),并在T2点A组显著高于B组(P<0.05)。复温时(T4)G(a-v)升高,ECC结束及手术结束时G(a-v)再次降低,低于基础值,组间均无显著差异。两组Lac在ECC开始后进行性升高,ECC结束达到峰值,在T4、T5及T6点A组均显著低于B组(P<0.05)。结论脑苷肌肽可提高体外循环心脏瓣膜置换术患者降温阶段脑糖利用,增加能量供应,减少乳酸生成。OBJECTIVE To investigate the effects of cattle encephalon glycoside and ignotin injection on cerebral glucose metabolism and lactate concentration in patients undergoing cardiac valve replacement with extracorporeal circulation （ECC）. METHODS Forty patients undergoing cardiac valve replacement with ECC were randomly divided into two groups ：cattle encephalon glycoside and ignotin injection group （group A ,n = 20） and control group （group B ,n = 20）. In group A cattle encephalon glycoside and ignotin injection 20ml was given i.v. after induction of anesthesia. In group B normal saline was given instead of cattle encephalon glycoside and ignotin injection. Blood samples were taken from jugular bulb after induction of anesthesia （ T1 ）, 33℃ cooling （ T2 ）, stable hypothermic duration （ T3 ）, 33℃ rewarming （ T4）, discontinuation of ECC （ T5 ） and discontinuation of operation （T6） for determination of arterial and jugular bulb blood glucose, utilization of glucose （G（a-v） ） and extraction of lactate（Lac）. RESULTS At points T2 and T3, G（a-v） in two groups was markedly lower than that at T1 （ P 〈 0.05 ）. At point T2, G（a-v） was significantly higher in group A than in group B （ P 〈 0.05 ）. The level of Lac increased after beginning of ECC and reached peak value at T5, At point T4,TSand T6,the level of Lac was significantly lower in group A than in group B（ P 〈 0.05 ）. CONCLUSION There is an inhibition of cerebral glucose metabolism during ECC and cattle encephalon glycoside and ignotin injection may improve cerebral glucose utilization,and decrease the extraction of lactate.

关 键 词：脑苷肌肽 神经节苷脂 体外循环 葡萄糖 

分 类 号：R654.2[医药卫生—外科学]