七氟烷对冠心病颅脑手术患者行控制性降血压的脑保护作用  

Neuroprotective Effect of Sevoflurane on Controlled Hypotension in Patients with Coronary Heart Disease Undergoing Craniocerebral Surgery

作　　者：杨云朝[1] 李进[1] 丰新民[1] 

机构地区：[1]武汉市第一医院麻醉科,武汉430022

出　　处：《医药导报》2014年第9期1164-1169,共6页Herald of Medicine

基　　金：武汉市卫生局科研基金资助项目(武卫[2010]42号WX10B02)

摘　　要：目的：探讨七氟烷对冠心病颅脑手术患者行控制性降血压的脑保护效应。方法冠心病颅脑手术患者26例,随机分为治疗组和对照组,各13例。所有患者在硬脑膜打开后开始行控制性降血压。对照组静脉泵注硝普钠为3~8μg·kg-1·min^-1,治疗组复合吸入2%～5%七氟烷。记录患者围手术期血流动力学变化、手术医生满意度及患者住院时间。分别于手术前1 d、手术结束时及手术后1 d,检测患者血清肌钙蛋白1（TNI）、肌酸激酶同工酶（CK-MBM）、神经元特异性烯醇酶（ NSE）和S100钙结合蛋白β（ S-100β蛋白）浓度。结果治疗组和对照组手术后住院时间分别为（20.3±3.8）,（23.9±4.6） d；与对照组比较,治疗组在控制性降血压期各时间点心率显著减低（均P＆lt;0.05）,手术后1 d NSE、S-100β蛋白均显著降低（P〈0.05）,手术医生满意度显著提高（P〈0.05）；与手术前1 d比较,手术结束时两组NSE、S-100β蛋白均显著升高（均P〈0.05）,手术后第1天TNI、CK-MBM、NSE、S-100β蛋白均显著升高（均P〈0.05）。与手术结束时比较,对照组NSE、S-100β蛋白均显著升高（均P〈0.05）。结论七氟烷对冠心病颅脑手术患者行控制性降血压不仅可有效保护脑组织,提高手术医生满意度,缩短患者住院时间,而且还能维持患者控制性降血压期间心肌的氧供需平衡；但不能防治冠心病患者手术后的心肌损伤。Objective To study the neuroprotective effect of sevoflurane on controlled hypotension in patients with coronary heart disease undergoing craniocerebral surgery. Methods Twenty-six patients with coronary heart disease undergoing craniocerebral surgery were randomly divided into two groups,receiving either inhaled 2%-5%sevoflurane plus intravenous sodium nitroprusside （treatment group,n=13） or intravenous sodium nitroprusside 3-8 μg·kg-1 alone （contorl group,n=13） for blood pressure control. The hemodynamic changes were recorded during the operation. Patient satisfaction with surgeons and the duration hospital stay after surgery were recorded. The levels of cardiac troponin I （TNI）,creatine kinase-MB （CK-MBM）,neuron specific enolase （ NSE） and S100 calcium binding proteinβ（ S-100βprotein） in serum were detected at one day pre-operation,the end of the operation,and one day post-operation. Results The duration of hospital stay after surgery was significantly shortened in treatment group [（20. 3±3. 8） versus （23. 9±4. 6） d,P〈0. 05） compared with control group. The average heart rate significantly decreased, patient satisfaction significantly increased, and serum levels of NSE and S-100β protein one day post-operation significantly decreased as compared to control group （all P〈0. 05）. Compared with the day before operation,serum levels of NSE and S-100βprotein in the two groups increased significantly at the end of surgery （P〈0. 05）,and the levels of TNI,CK-MBM,NSE and S-100βsignificantly elevated one day post-operation （P〈0. 05）. Compared with the end of operation,serum levels of NSE and＆amp;nbsp;S-100βin contorl group incarcerated remarkably （P〈0. 05） Conclusion Sevoflurane plays an important neuroprotective role,as evidenced by improving patients’; satisfaction,reducing hospital stay after surgery,and maintaining the balance of myocardial oxygen delivery and consumption in craniocerebral surgery patients with coronary heart disease during con

关 键 词：七氟烷 硝普钠 降血压 控制性 脑保护 钙结合蛋白质类 神经元特异性烯醇酶 

分 类 号：R971.2[医药卫生—药品] R651.1[医药卫生—药学]