七氟醚后处理对体外循环心内直视手术患者围手术期脑保护作用  

The perioperative brain protection of sevoflurane postconditioning in patients with cardiopulmonary bypass open heart surgery

作　　者：韩文冬[1] 张丽娟[1] 

机构地区：[1]河南省安阳市人民医院麻醉科,河南安阳455000

出　　处：《中国现代医学杂志》2012年第22期96-99,共4页China Journal of Modern Medicine

摘　　要：目的观察七氟醚后处理对体外循环(CPB)心内直视手术围术期患者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。方法择期行二尖瓣置换术患者56例,性别不限,ASA分级Ⅱ或Ⅲ级,年龄32～67岁,体重51～95 kg,随机分为2组(n=28):对照组(C组)和七氟醚组(S组)。S组组经体外循环于主动脉开放时以2%七氟醚灌入血液循环15 min,C组不作以上处理,采用全凭静脉麻醉。分别于CPB开始前(T1)、CPB期间降鼻咽温降至28℃时(T2)、心脏复跳时(T3)、心脏复跳30 min时(T4)以及CPB结束后6 h(T5)时采集桡动脉和颈内静脉球部血样,进行血气分析并测定颈内静脉血S100β和NSE蛋白的浓度。结果 T1时两组患者各指标无明显变化(P>0.05);随着温度逐渐降低,两组颈内静脉球氧饱和度(SjvO2)升高,动脉-颈内静脉血氧含量差(Da-jvO2)和氧摄取率(CERO2)都降低(P<0.05);复跳时两组SjvO2较CPB前降低,而Da-jvO2、CERO2则升高(P<0.05);两组患者S100β和NSE蛋白水平在CPB开始后血浆浓度逐渐升高,复温期达到峰值,以后逐渐降低;两组各指标比较,S组的变化幅度要明显低于C组。结论体外循环(CPB)心内直视手术围术期患者行七氟醚后处理更有利于脑氧代谢的改善和脑损伤的保护。【Objective】To observe perioperative cerebral oxygen supply-demand balance and brain injury markers S100β and neuron-specific enolase（NSE） protein concentration in patients with cardiopulmonary bypass（CPB） open heart surgery.【Methods】56 patients with selective mitral valve replacement,either sex,ASA grade Ⅱ or Ⅲ,age 32 to 67 years old,weighed 51～95 kg were randomly divided into 2 groups（n =28）：Control group（group C） and sevoflurane group（group S）.Group S poured into the blood circulation 2% sevoflurane 15 min when aortic opening during CPB,Group C without more treatment but with the total intravenous anesthesia.The radial artery and internal jugular vein bulb blood samples were captured for blood gas analysis and the concentration of S100β and NSE protein in jugular venous blood before CPB（T 1）,CPB were determined during the nasopharyngeal temperature dropped to 28℃（T 2）,cardiac resuscitation（T 3）,30 min after cardiac resuscitation（T 4） and after 6h after CPB（T 5）.【Results】The two groups showed no significant changes during T 1（P0.05）;as the temperature decreased,the jugular vein oxygen saturation（SjvO 2） increased but the arterial-jugular venous oxygen content difference（Da-jvO 2） and oxygen uptake rate（CERO 2） were lower（P 0.05）;compared with T3,the SjvO 2 value was lower but Da-jvO 2 andCERO 2 were higher compared with T1 in both two groups.S100β and NSE protein levels in the plasma concentrations were increased gradually after CPB and to peak time during cardiac resuscitation（T3） and then gradually decreased.Compared group C,the magnitude changes of parameters in S group were significantly lower.【Conclusion】Sevoflurane postprocessing in patients with CPB open heart surgery patients perioperative is more conducive to improve cerebral oxygen metabolism and brain protection.

关 键 词：七氟醚 后处理 体外循环 脑保护 

分 类 号：R619[医药卫生—外科学]