ECC中不同双频指数下丙泊酚或硫贲妥钠对脑氧代谢的影响  

The Effects of Propofol or Etomidate on Cerebral Oxygen Extraction Under Different Bispectral Index During Hypothermic Cardiopulmonary Bypass

作　　者：张磊[1] 金沐[1] 李立环[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院麻醉科,北京100037

出　　处：《中国分子心脏病学杂志》2007年第6期359-363,共5页Molecular Cardiology of China

基　　金：北京市优势专科疾病防治研究资助项目(H030930020290)

摘　　要：目的在CABG手术中浅低温体外循环(ECC)时,给予大剂量丙泊酚或硫贲妥钠,至BIS为0,探讨在BIS不同抑制程度时,其对脑氧代谢的影响。方法27例ECC下行CABG病人,随机分为对照组、丙泊酚组和硫贲妥钠组。分别在给药前、后BIS下降到不同程度直到0时,抽取颈内静脉球部血液和桡动脉血液计算COE。结果各组在各个时间点的COE均无差异。结论在低温体外循环中丙泊酚或硫贲妥钠对BIS的抑制程度,与剂量呈正相关;使BIS下降到0的剂量的丙泊酚或硫贲妥钠在浅低温ECC中低温时,没有改变脑氧摄取率(COE);BIS可以反映麻醉药对脑代谢的抑制程度,其精确的相关性,有待于今后进一步实验研究。Objective The bispectral index （ BIS）, a value derived from the electroencephalograph （EEG） , has been proposed as a measurement of cerebral metabolism. This prospective study is designed to evaluate and compare the effects of high doses propofol or thiopental of BIS zero on cerebral oxygen extraction （COE） during light hypothermic ECC in selective CABG patients. Methods Patients （n = 27 ） were randomly entered into one of the three groups ： control , propofol or thiopental group. All the study drugs were given to the subclavicular vein after aortic artery clamping until BIS zero. The blood gas samples were drawn from the radial artery and jugular venous bulb before the drugs were given （ baseline point） , and when BIS was inhibited to 75%, 50%, 25% and 0% （BIS=0） of baseline point （P, T or E group）, or on the points 5, 10, 20, 30 rain after the NS was given（ control group）. The COE was calculated and hemodynamic data were recorded. The relationships between BIS and inhibit time, as well as return time were determined by regression analysis for both the individual drugs and, when appropriate, for the pooled results. Results There was no difference of COE among the groups. The BIS changes caused by 1% propofol,or 2.5% thiopental correlated linearly with either inhibit time （ r = 0. 855, or 0. 831, respectively. P 〈 0. 01 ） or return time（r=0.852, or0.705, respectively. P〈0. 01）. Conclusions The changes of BIS caused by 1% propofol or2.5% thiopental was negatively correlative with their doses during light hypothemic ECC. All the study drugs can reduce BIS to zero. The high doses of propofol or thiopental of BIS zero can not change COE.

关 键 词：丙泊酚 硫贲妥钠 双频指数 脑氧摄取率 

分 类 号：R614[医药卫生—麻醉学]