异丙酚和氯胺酮持续静脉端输注对体外循环心脏直视手术中脑损伤的保护作用  

Protective effects of continuous intravenous port infusion Propofol and Ketamine on brain injuries during cardiac surgery with cardiopulmonary bypass

作　　者：李清[1] 罗向红[1] 高美玲[1] 杨亚婷[1] 王贤裕[1] 

机构地区：[1]湖北医药学院附属太和医院麻醉科,湖北十堰442000

出　　处：《中国医药导报》2014年第9期123-126,129,共5页China Medical Herald

基　　金：湖北省自然科学基金项目(编号2012FFC060)

摘　　要：目的 探讨异丙酚和氯胺酮持续静脉端输注对体外循环心脏直视手术中脑损伤的保护效应.方法 将择期行体外循环（CPB）心内直视手术患者90例随机分为三组,每组30例.A组为对照组,B组和C组为实验组,A组常规CPB,不行氯胺酮/异丙酚持续静脉端输注,B组在CPB期间氯胺酮/异丙酚1∶1混合1 mg/（kg·h）微泵持续静脉端输注,C组在CPB期间氯胺酮/异丙酚1∶1混合2 mg/（kg·h）微泵持续静脉端输注.常规低温体外循环麻醉处理,维持循环稳定.所有病例均在麻醉诱导后（TS1）,CPB结束后1 h（TS2）、24h（TS3）、48 h（TS4）四个时点各取颈内静脉血3 mL备检S1001β蛋白;在麻醉诱导后（TN1）,CPB结束后24 h（TN2）、48 h（TN3）、72 h（TN4）各取颈内静脉血3 mL备检神经元性烯醇化酶（NSE）.S100β蛋白与NSE均采用酶联免疫法测定.所有病例均在麻醉诱导后（T1）、CPB开始后5 min（T2）、CPB低温稳定期鼻咽温（28～32℃）（T3）、复温至鼻咽温34℃（T4）及停CPB后5 min（T5）5个时点取颈内静脉血测定颈内静脉氧饱和度（SjvO2）.结果 所有患者的血清S100β蛋白值均在TS2升高,TS3回至基础值;血清NSE值均在TN2后升高,TN4回复基础值.与A组比较,B组和C组TS2的血清S100β蛋白值[（3.97±0.65）、（2.78±0.10）μg/L]及TN2的血清NSE值[（9.73±1.57）、（8.36±1.67）μg/L]差异有高度统计学意义（P＜0.01）.C组与B组相比,患者TS2血清S100β蛋白及TN2血清NSE水平差异有统计学意义（P＜0.05）.90例患者SjvO2在T2-3升高,T4时轻度降低,T5回复基础值.A组与B、C组比较,T3[B组：（88.7±6.2）％;C组：（89.8±7.5）％]、T4[B组：（67.6±3.9）％;C组：（69.3±4.3）％]SjvO2值差异有统计学意义（P＜0.05）,其他各时点组间比较差异无统计学意义（P＞0.05）,所有患者均无永久性中枢神经系统功能障碍.结论 CPB期间产生可逆性脑损伤,异丙酚/氯胺酮持续静脉端输注Objective To investigate the protective effects of continuous intravenous port infusion Propofol and Ketamine on brain injuries during cardiac surgery with cardiopulmonary bypass.Methods 90 patients undergoing selective CPB were randomly divided into three groups with 30 cases in each：control group （group A）,experimental groups （group B and C）.Patients in group A were administered CPB regularly without Propofol or Ketamine intravenous port infusion.In group B,Propofol and Ketamine （1∶1） was continuously intravenous port infused of 1 mg/（kg ·h） throughout CPB.In group C,Propofol and Ketamine （1∶1） was continuously intravenous port infused of 2 mg/（kg·h） throughout CPB.All patients were given by anesthesia treatment of conventional hypothermic cardiopulmonary bypass and maintained circulation stability.Blood samples （3 mL） of 90 patients were collected from internal carotid vein after induction of anesthesia （TS1）,1 hour （TS2）,24 hours （TS3） and 48 hours （TS4） after CPB to assay the changes of plasma level of S100β protein.Blood samples （3 mL） were taken from jugular vein of all cases after induction of anesthesia （TN1）,24 hours （TN2）,48 hours （TN3） and 72 hours （TN4） after CPB to assay the changes of plasma level of neuronspecific enolase （NSE）.S100β protein and NSE were tested by euzymelinked immunosorbent assay.Blood samples were collected from internal carotid vein of all patients after induction of anesthesia （T1）,5 minutes after the start of CPB （T2）,nasopharyngeal temperature being cooled down to 28-32℃ during hypothermia stability period of CPB （T3）,rewarming to 34℃ （T4） and 5 minutes after CPB （T5） to assay the changes of SjvO2,partial pressure of oxygen,and hemoglobin contents.Results S100β protein of ninety patients began to rise 1 hour after CPB and dropped to baseline values within 24 hour after CPB.NSE began to rise 24 hours after CPB and dropped to baseline values within 72 hours after CPB.The plasm

关 键 词：异丙酚 氯胺酮 脑保护 体外循环 S100Β 神经元性烯醇化酶 

分 类 号：R614.2[医药卫生—麻醉学]