异氟烷和异丙酚对体外循环心内直视手术患者围术期脑氧代谢和脑损伤影响的研究  

Effects of Propofol and Isoflurane on the Cerebral Oxygen Metabolism and Cerebral Injury during Cardiopulmonary bypass： a Comparative Study

作　　者：郭建荣[1] 任利远[1] 杜金满[1] 陈小非[1] 胡礼宏[1] 余雷霆[1] 

机构地区：[1]宁波大学医学院附属享惠利医院麻醉科,浙江宁波315040

出　　处：《麻醉与监护论坛》2010年第1期28-31,共4页Forum of Anesthesia and Monitoring

摘　　要：目的：观察异氟烷和异丙酚麻醉对体外循环（CPB）心内直视手术患者围术期脑氧供需平衡及脑损伤标记物S100β和神经元性烯醇化酶（NSE）蛋白浓度的影响。方法：将30例择期行体外循环瓣膜置换手术病人随机分为异氟烷麻醉组和异丙酚麻醉组。分别于CBP开始前（T1）、鼻咽温降至稳定期（L）．复温至36℃（T3），CBP结束后30m；n（T4）．CPB结束后6h（T5）和CPB结束后24h（T6）抽取桡动脉血和颈静脉球部血样检测血气并测定颈内静脉血S-100B和NSE蛋白的浓度。结果：CPB前两组患者颈内静脉球氧饱和度（Sjv02），动脉一颈内静脉血氧含量差（Da—jv02）及氧摄取率（CERO2）和脑损害标记物s100B及NSE蛋白浓度差异无统计学意义（P〉0．05）；随着降温逐渐加深两组Sjv02明显升高．Da—jvO2和CERO2明显降低．复温开始后两组SjvO2较CPB前明显降低，而Da—jvO2．CERO2则明显升高（P〈0．05）；CPB开始后两组血浆s100β和NSE蛋白浓度逐渐升高。复温期达到峰值．s100β蛋白浓度在停机24h后恢复至基础水平，NsE蛋白浓度仍略高于CPB前水平；两组各指标比较．异丙酚组的变化幅度要明显低于异氟烷组。结论：两种麻醉方式均可满足CPB下瓣膜置换手术的需要，与异氟烷组比较．异丙酚麻醉更有利于CBP下患者脑氧代谢的改善和脑损伤的保护。Purpose To observe the effects of isoflurane and propofol on the changes of cerebral oxygen supply-demands balance and serum concentration of S100β and NSE protein in cardiac valve replacement during cardiopulmonary bypass（CPB）. Methods All of 30 patients undergoing heart valve replacement were prospectively randomized divided into isoflurane group（with isoflurane adoption） and propofol group^with propofol adoption）, 15 cases each. Jugular venous bulb blood oxygen saturation（SjvO2）, Jugular arterial-venous oxygen content difference（Da-jvO2） and cerebral oxygen extraction rate （CERO2） and radical artery blood gas analysis were measured at six stages（T1-T6） of CPB before CPB（T1）, Bring down the temperature to stability stage（T2）= recovery temperature to 36℃（T3） 30min （T4）, 6 hours（T5） and 24 hours （T6）after CPB. The jugular venous bulb blood was taken at the six time points to measure the blood concentration of S100β and NSE protein. Results SjvO2 in the two groups were both increased during cooling period and then decreased during rewarming period, but the change in propofol group is less than that in the isoflurane group（P〈0.01）. The blood concentrations of S100β protein and NSE protein were both increased after CPB, but the concentration protein in propofol group were lower than in isoflurane group（P〈0.05）. Conclusion： Propofol has better cerebral protective effects than isoflurane in cardiac valve replacement surgery with CPB.

关 键 词：异氟烷 异丙酚 体外循环 脑氧代谢 脑损害 

分 类 号：R654.1[医药卫生—外科学]