异丙酚不同镇静深度对体外循环心脏瓣膜置换术患者脑损伤的影响  

Effects of different sedation depths of propofol on brain injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass

作　　者：张瑜[1] 张铁铮[1] 孙莹杰[1] 周锦[1] 

机构地区：[1]110016沈阳市,沈阳军区总医院麻醉科

出　　处：《中华麻醉学杂志》2013年第9期1040-1043,共4页Chinese Journal of Anesthesiology

基　　金：辽宁省自然科学基金（20102244）

摘　　要：目的 评价异丙酚不同镇静深度对体外循环（CPB）心脏瓣膜置换术患者脑损伤的影响.方法 择期CPB下行心脏瓣膜置换术患者45例,ASA分级Ⅲ或Ⅳ级,性别不限,年龄26 ～ 64岁,体重50 ～ 85 kg,根据术中镇静深度分为3组（n=15）：A组,30≤BIS值＜40;B组,40≤BIS值≤50;C组,50＜ BIS值≤60.静脉注射利多卡因、咪达唑仑、舒芬太尼、依托咪酯和罗库溴铵诱导麻醉,气管插管后行机械通气,维持PETCO2 35 ～45 mm Hg.静脉输注异丙酚,A组、B组和C组的速率分别为7、5、3mg·kg-·h-1,间断静脉注射舒芬太尼和哌库溴铵,间断吸入七氟醚维持麻醉.术中通过调节异丙酚输注速率维持各组相应的麻醉深度.分别于CPB前（T1）、CPB 30 min（T2）、CPB结束即刻（T3）和CPB结束后1 h（T4）时,采集桡动脉和颈内静脉球部血样,采用ELISA法测定血浆S-100β蛋白浓度,行血气分析,计算动脉-颈静脉球血氧含量差（Da-jO2）、脑氧摄取率（CERO2）和颈静脉球-动脉血乳酸含量差（Dj-aL）.结果 与C组比较,A组和B组T3-4时血浆S-100β蛋白浓度降低,SjvO2升高,Da-jO2和CERO2降低,T3时Dj-aL降低（P＜0.05）；与B组比较,A组T.时血浆S-100β蛋白浓度降低,T2时SjvO2升高,Da-jO2和CERO2降低,T3时Dj-aL降低（P＜0.05）.结论 适度加深异丙酚镇静深度（30≤BIS值＜ 40）有利于减轻CPB心脏瓣膜置换术患者的脑损伤.Objective To evaluate the effects of different sedation depths of propofol on brain injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass （CPB）.Methods Forty-five ASA physical status Ⅲ or Ⅳ patients of both sexes,aged 26-64 yr,weighing 50-85 kg,scheduled for elective cardiac valve replacement with CPB,were divided into 3 groups according to intraoperative sedation depths （n =15each）：30 ≤ bispectral index （BIS） value 〈 40 （group A） ; 40 ≤ BIS value ≤ 50 （group B） ; 50 〈 BIS value ≤ 60（group C）.Anesthesia was induced with iv injection of lidocaine,midazolam,sulfentanil,etomidate and vecuronium.The patients were tracheally intubated and mechanically ventilated.PET CO2 was maintained at 35-45 mm Hg.Anesthesia was maintained with iv infusion of propofol at a rate of 7,5 and 3 mg· kg-1 · h-1 in A,B and C groups,respectively,intermittent iv boluses of sulfentanil and pipecuronium,and intermittent inhalation of sevoflurane.The infusion rate of propofol was adjusted to maintain the corresponding anesthesic depth in each group.Before CPB （T1）,at 30 min of CPB （T2）,immediately after termination of CPB （T3） and at 1 h after the end of CPB （T4）,blood samples were obtained from the jugular bulb vein and radial artery for determination of plasma S-100β protein concentration and for blood gas analysis,and the arterial to venous blood oxygen content difference （Dj-aO2）,cerebral O2 extraction rate （CERO2） and jugular bulb venous to arterial blood lactic acid content difference （Dj-aL） were calculated.Results Compared with group C,the plasma S-100β protein concentrations were significantly decreased,SjvO2 was increased,and Dj-aO2 and CERO2 were decreased at T3-4,and Da-jL was decreased at T3 in groups A and B （P 〈 0.05）.Compared with group B,the plasma S-100β protein concentrations were significantly decreased at T3-4,SjvO2 was increased at T2,Da-jO2 and CERO2 were decreased at T2,and DajL was decreased at T3 in group A �

关 键 词：二异丙酚 清醒镇静 心肺转流术 脑损伤 

分 类 号：R614[医药卫生—麻醉学]