不同剂量异丙酚对浅低温体外循环心内直视手术病人脑静脉血浆S-100蛋白和NSE的影响  

Effects of different doses of propofol on cerebral venous blood S-100 protein and neuron-specific enolase in patients undergoing open heart surgery under CPB at mild hypothermia

作　　者：金沐[1] 李立环[1] 

机构地区：[1]中国医学科学院中国协和医科大学阜外心血管病医院麻醉科,北京市100037

出　　处：《中华麻醉学杂志》2008年第1期18-21,共4页Chinese Journal of Anesthesiology

基　　金：北京市优势专科疾病防治研究资助项目（H030930020290）

摘　　要：目的探讨不同剂量异丙酚对浅低温体外循环（CPB）心内直视手术病人脑静脉血浆S-100蛋白和神经元特异性烯醇化酶（NSE）的影响。方法择期心内直视手术病人32例，随机分为3组：低剂量异丙酚组（Ⅰ组，n=10）、高剂量异丙酚组（Ⅱ组，n=7）和咪达唑仑组（Ⅲ组，n=15）。CPB开始时，Ⅰ组经5～10min静脉注射异丙酚1mg／kg，然后静脉输注3mg·kg^-1·h^-1至CPB结束；Ⅱ组经5～10min静脉注射异丙酚1mg／kg，然后静脉输注6mg·kg^-1·h^-1至CPB结束；Ⅲ组静脉输注咪达唑仑0．2mg·kg^-1·h^-1至CPB结束。于CPB开始前（基础值，T0）、鼻咽温（NPT）降温至32℃（T1）、NPT复温至36℃（T1）、CPB结束后30min（T3）、4h（T4）和24h（T5）时采集颈内静脉球部血，测定血浆S-100蛋白和NSE浓度。连续监测平均动脉压（MAP）和颈静脉球压（JBP），并计算脑灌注压（CPP=MAP—JBP）。结果与T0时比较，Ⅰ组T2-4。时NSE浓度升高，Ⅱ组T1-4时升高，Ⅲ组T1-5，时升高，3组T1-3时S-100蛋白浓度均升高（P〈0．05）；3组间各时点NSE和S-100蛋白浓度比较差异无统计学意义（P〉0．05）。结论异丙酚对浅低温体外循环心内直视手术病人脑静脉血浆S-100蛋白和NSE的释放无影响。Objective To assess the effects of different doses of propofol on cerebral venous blood S-100 protein and neuron-specific enolase （NSE） in patients undergoing open heart surgery under cardiopulmonary bypass （CPB） at mild hypothermia. Methods Thirty-two ASA Ⅱ or Ⅲ patients aged 19-49 yr weighing 44-62 kg undergoing elective open heart surgery were randomly allocated into 3 groups： group I low-dose propofol （3 mg· kg^-1 · h^-1 ） （ n = 10） ; group Ⅱ high-dose propofol （6mg· kg^-1 · h^-1 ） （ n = 7） and group Ⅲ midazolam （0.2mg· kg^-1 · h^-1 ） （ n = 15 ）. Left internal jugular vein was cannulated and the catheter was advanced cephalad until jugular bulb for blood sampling. Blood samples were obtained before CPB （To, baseline）, when naso-pharyngeal tempera ture （NPT）was reduced to 32℃ （T1）, when NPT returned to 36℃ （T2）, 30 min, 4 h and 24 h after termination of CPB （T3 , T4, T5 ） for determination of plasma S-100 protein and NSE concentrations. MAP and JBP were continuously monitored and CPP was calculated. Results Plasma NSE concentration was increased at T2-4 in group Ⅰ , at T1-4 in group Ⅱ and at T1-5 in group Ⅲ as compared with the baseline values at T0 . Plasma S-100 protein concentration was increased at T1-3 in three groups as compared with the baseline values at To . Conclusion Propofol has no effect on the release of S-100 protein and NSE during open heart surgery performed under CPB at mild hypothermia.

关 键 词：二异丙酚 磷酸丙酮酸水合酶 S100蛋白质类 心肺转流术 低温 人工 脑 

分 类 号：R686[医药卫生—骨科学]