七氟醚预处理对心肺转流后患者脑损伤的影响  

Effect of sveoflurane preconditioning on cerebral injury in patients undergoing cardiac surgery with cardiopulmonary bypass

作　　者：吴周全[1,2] 崔苏扬[1] 李立[2] 

机构地区：[1]南京中医药大学第一临床学院,210029 [2]南京医科大学附属常州第二人民医院麻醉科

出　　处：《临床麻醉学杂志》2013年第5期439-442,共4页Journal of Clinical Anesthesiology

基　　金：常州市卫生局指导项目(WZ201111)

摘　　要：目的观察七氟醚预处理对心肺转流(CPB)患者脑损伤的影响。方法 30例择期CPB下心内直视手术患者,随机分为七氟醚预处理组(S组)和对照组(C组)。S组手术开始至CPB前吸入2%七氟醚20min,随后予以10min的洗脱期,而C组患者只吸入纯氧。两组患者均于术后7d行脑事件相关电位测试,记录N1、P2、N2、P3的潜伏期(L)和P3的振幅(A);于麻醉诱导前(T0)、CPB后30min(T1)、主动脉开放后(T2)和停CPB后6h(T3)、12h(T4)、24h(T5)经颈内静脉逆向置管取血测定神经元特异性烯醇化酶(NSE)、S-100β、血管内皮素-1(ET-1)、一氧化氮(NO)浓度。结果与T0时比较,T1～T4时两组患者NSE、S-100β、ET-1浓度均明显升高(P<0.01)。与C组比较,T1～T5时S组NSE、S-100β、ET-1浓度明显降低(P<0.01),T5时S组NSE、S-100β浓度则基本恢复到T0时,而C组仍高于T0时(P<0.01)。T1～T5时两组患者NO浓度差异无统计学意义。与C组比较,S组患者LN2、LP3明显缩短、AP3明显增加(P<0.05)。结论七氟醚预处理能减轻CPB后引起的脑损伤及潜在的认知功能损害,可能与其降低ET-1含量、增加CPB脑血流灌注有关。Objective To investigate the effect of sevoflurane preconditioning on cerebral injury in patients undergoing cardiac surgery with cardiopulmonary bypass （CPB）. Methods Thirty patients were randomly allocated to one of two groups （n= 15 each） ： control group （group C） and sevoflurane preconditioning group （group S）. In group S, 2%sevoflurane was inhaled for 20 rain from skin incision, and followed oxygen elution for 10 rain. while in group C, the patients inhaled only 100% 02. The latence of wave N1, P2, N2 and P3 and the amplitude of wave P3 were tested by Auditory oddball stimulation ERP on the 7th day posvsurgery. Blood samples were obtained from internal jugular vein before induction of anesthesia （T0）, 30 min after the initiation of CPB （T1）, at the time of aotic unclamping （T2）, 6 h（T3 ）, 12 h（T4 ）and 24 h （T5） after discontinuation of CPB for deter ruination of plasma levels of neuron specific enolase （NSE）, S-100β, endothelin-1 （ET-1） and nitrogen monoxidum（NO）. Results Plasma levels of NSE, S-100β, ET-1 were significantly increased at T1-T4 compared with the baseline at To in Both groups and were lower in group S than in group C （P〈0. 01）, while the levels of NSE and S-100β recover to baseline at Ta. There were no significant difference on the levels of NO at T1 T5. The latencies of wave LNe and Lea were lower, while the amplitud of wave Am were higher than in group C （P 〈 0. 05 ）. Conclusion Sevoflurane preconditioning can effectively ameliorated cerebral injury, which may be associated with the improvement of cerebral blood flow induced by sevoflurane during CPB.

关 键 词：七氟醚 心肺转流 神经元特异性烯醇化酶 内皮素-1 事件相关电位 

分 类 号：R614[医药卫生—麻醉学]