异丙酚对心内直视手术病人颅内血浆兴奋性氨基酸水平的影响  

Influence of propofol on excitatory amino acids levels of intracranial venous blood during open heart surgery

作　　者：于灵芝[1] 刘慧贞[1] 张银中 宋振瑞[1] 

机构地区：[1]山东省立医院麻醉科,济南250021

出　　处：《中华麻醉学杂志》1999年第8期465-467,共3页Chinese Journal of Anesthesiology

摘　　要：目的　观察低温体外循环（ＣＰＢ）心内直视手术相中颅内静脉血中兴奋性氨基酸（ＥＡＡｓ）的变化及复温过程中应用异丙酚的作用。方法　择期心内直视手术病人３０ 例，随机分为对照组及观察组（复温过程中经人工心肺机注入异丙酚）。于麻醉诱导后ＣＰＢ前（Ａ）、降温３３℃时（Ｂ）、低温稳定期（Ｃ）、复温３３℃时（Ｄ）、复温开始后１ 小时（Ｅ）和２小时（Ｆ）经颈内静脉逆行置管取血样检测血浆ＥＡＡｓ浓度。结果　甘氨酸（Ｇｌｙ）两组Ｂ、Ｃ、Ｄ点值均明显高于Ａ 点；谷氨酸（Ｇｌｕ）对照组Ｄ点较Ａ点明显升高；天冬氨酸（Ａｓｐ）对照组Ｄ点较Ａ 点显著升高，并明显高于观察组。结论　体外循环心内直视手术中颅内静脉血ＥＡＡｓ浓度升高，复温过程中应用异丙酚可减少Ｇｌｕ、Ａｓｐ 水平的升高，但对Ｇｌｙ 无影响。Objective To observe the changes of excitatory amino acids(EAAs)levels in intracranial venous blood during open heart surgeries under cardiopulmonary bypass(CPB)and the influence of propofol on it when used perirewarmingly.Methods Thirty patients for selective open heart surgeries were randomly divided into two groups.In group I propofol 1.0 mg·kg -1 was intravenously administered 5 10 min before the start of rewarming and consequently was infused at the rate of 100μg·kg -1 ·min -1 till the end of rewarming.The group Ⅱ servered as control without any administration.Blood samples were taken via retrograded jugular blub cannula prior to CPB(A),following 33℃ cooling (B),during the deepest temperature(C),at onset of rewarming(D),1h(E)and 2h(F) after the onset of rewarming,to measure the plasma concentrations of EAAs including glutamate(Glu),aspartate(Asp) and glysine(Gly).Results As compared with the levels before CPB,Glu value increased significantly at D in group Ⅱ (P<0.05),and remained unchanged in group Ⅰ(P> 0.05 ),in which there was not significant difference between both groups(P>0.05);Asp value rose markedly at D in group Ⅱ(P<0.05),but decreased obviously at F in group Ⅰ(P<0.05),in which there were significant differences at D and F between both groups (P<0.05);Gly value increased greatly at B,C and D in both groups (P<0.05) without the significant differences in the elevated degree between both groups(P>0.05).Conclusion EAAs in intracranial venous blood increase highly during open heart surgeries under CPB.The usage of propofol in the duration of rewarming may diminish the increases of Glu and Asp,but do not influence on Gly level.

关 键 词：心肺转流术 二异丙酚 兴奋性氨基酸类 

分 类 号：R654.2[医药卫生—外科学]