体外循环中丙泊酚、依托咪酯或硫贲妥钠对双频指数和脑氧代谢的影响  

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

作　　者：张磊[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北京阜外心血管病医院麻醉科,北京100037

出　　处：《实用临床医药杂志》2008年第2期10-14,18,共6页Journal of Clinical Medicine in Practice

摘　　要：目的观察在BIS不同抑制程度时，硫贲妥钠、丙泊酚或依托咪酯对脑氧代谢的影响。方法随机选择35名CPB下CABG病人，分为4组，对照组（C组）、丙泊酚组（P组）、硫贲妥钠组（T组）、依托咪酯组（E组），监测BIS；术中PaCCh控制在35-40mmHg，鼻咽温度为32--3412，泵流量2．4L／（min·m^2）；P组予1％丙泊酚、T组予2．5％硫贲妥钠、E组予0．2％依托咪酯，对照组予生理盐水，以150mL／h的速度从锁骨下静脉注入；P组、T组和E组分别在给药前、BIS下降到给药前75％、50％、25％和BIS为0时，对照组在给药前、给药后5、10、20、30min时，以及所有组在纵开胸骨后5min和关胸后5min时，抽取颈内静脉球部血液和桡动脉血液以α稳态监测血气，计算COE。结果①各组在开胸后5min、给药前、BIS抑制25％、50％、75％和100％，以及关胸后5min的COE无差异。②1％丙泊酚、2．5％硫贲妥钠或0．2％依托咪酯引起的BIS下降，与对应的给药时间呈直线相关（r=0．855、0．831或0．720）；比较各回归直线斜率，E组较P组和T组均有极显著差异（P〈0．01），P组和T无显著差异（P〉0．05）。停药后BIS恢复的数值与对应时间呈直线相关（r=0．852、0．705或0．815）；比较各回归直线斜率，P组较r组和E组均有极显著差异（P〈0．01），T组和E组无显著差异（P〉0．05）。结论CPB中丙泊酚、硫贲妥钠和依托咪酯对BIS的抑制程度，与剂量呈正相关，且没有改变COE。3种药物都能使BIS下降到0，能降低脑代谢，在CPB中对大脑有保护作用。Objective The bispectral index （BIS） cephalograph （EEG）, has been proposed as a measure of , a value derived from the electroen- cerebral metabolism. This prospective study is designed to evaluate and compare the effects of high dose propofol, thiopental or etomidate of BIS zero on cerebral oxygen extraction （COE） during light hypothermic pulmonary bypass in selective CABG patients. Methods Patients （ n = 35） were randomly entered into one of the four groups： control（NS, n =9）, P （1% propofol, n =9）, T （2.5% thiopental, n =9）, or E （0.2% etomidate, n = 8）group. A standard two-channel bifrontal montage was applied for BIS monitor. The CPB was controlled during the hypothemic period with 2.4 L/（min·m^2） pump flow, 32 ℃- 34℃ nasopharyngeal temperature, and 35--40 mmHg PaCO2. All the study drugs were given to the subclavicular vein by 150 mL/min after aotic 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 point 5, 10, 20, 30 min after the NS was given（control group）. The COE was calculated and hemodynamic data were recorded. MAP was controlled within a range 50- 90 mmHg by nitroglycerine or pheylephrine. All the tubation time and the neuropsychological defects. patients were observed after operation for the extubation time and the neuropsychological defects. The relationship between BIS and inhibit time as well as return time was 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 causedly 1% propofol, 2.5% thiopental or 0.2% etomidate, correlated linearly with either inhibit rime （ r = 0. 855, 0. 831, or 0. 720, respectively） or the return time（r = 0. 852, 0. 705, or 0. 815, respectively）. There was a signific

关 键 词：丙泊酚 依托咪酯 硫贲妥钠 脑 氧代谢 

分 类 号：R654.1[医药卫生—外科学]