七氟烷预处理与后处理对体外循环心脏瓣膜置换术患者心脑功能的保护作用  

Protective effect of sevoflurane preconditioning and postconditioning on heart and brain function in patients undergoing cardiac valve replacement under cardiopulmonary bypass

作　　者：吴立文 朱海文 冯世军 吴学志 Wu Liwen;Zhu Haiwen;Feng Shijun;Wu Xuezhi(Zhumadian Central Hospital,Zhumadian 463000,Henan,China)

机构地区：[1]驻马店市中心医院,河南驻马店463000

出　　处：《临床心身疾病杂志》2022年第1期57-62,共6页Journal of Clinical Psychosomatic Diseases

基　　金：河南省科技攻关计划项目(编号172102310101)。

摘　　要：目的探讨七氟烷预处理与后处理对体外循环心脏瓣膜置换术患者心脑功能的保护作用。方法将91例心脏瓣膜置换术患者按照七氟烷处理方法分为预处理组42例与后处理组49例,预处理组在麻醉诱导完成后即灌注2%七氟烷30min,后处理组在主动脉开放后至体外循环结束心脏复跳之间灌注2%七氟烷30min。比较两组手术情况,术中及术后心血管活性药物用量,不同时间点心脑血清标志物水平,心肌缺血事件、心律失常发生率及心脏复跳情况,术后谵妄、认知功能。结果两组体外循环时间、主动脉瓣阻断时间、手术时间、麻醉时间、机械通气时间、重症加强护理病房停留时间比较差异无统计学意义(P>0.05)。术中及术后两组去甲肾上腺素、多巴酚丁胺用量比较差异无统计学意义(P>0.05)。不同时间点两组肌酸激酶、肌酸激酶同工酶、肌钙蛋白I、S100β蛋白、神经元特异性烯醇化酶组间、时间及交互效应差异有统计学意义(P<0.05)。两组心肌缺血事件及心率失常发生率、心脏复跳情况、谵妄评定量表评分、谵妄发生率、简易智能状态检查量表及蒙特利尔认知评估量表评分比较差异无统计学意义(P>0.05)。结论七氟烷预处理对体外循环心脏瓣膜置换术患者心脑功能的保护作用相对更佳,但并未引起明显的手术进程、手术结局差异,值得临床重视。Objective To explore the protective effect of sevoflurane preconditioning and postconditioning on heart and brain function in patients undergoing cardiac valve replacement under cardiopulmonary bypass(CPB).Methods A total of 91 patients with cardiac valve replacement were divided into preconditioning group(n=42) and postconditioning group(n=49) according to sevoflurane treatment.The preconditioning group was treated with infusion of 2% sevoflurane for 30 minutes after anesthesia induction,and the postconditioning group was treated with infusion of 2% sevoflurane for 15 minutes between aorta opening and cardiac rebeating at the end of CPB.The surgical conditions,intraoperative and postoperative dosages of cardioactive drugs,cardiac and cerebral serum markers,myocardial ischemic events,arrhythmia,cardiac rebeating,postoperative delirium and cognitive function were compared between the two groups.Results There was no statistically significant difference in CPB time,aortic cross-clamp time,operation time,anesthesia time,mechanical ventilation time and residence time in intensive care unit(ICU) between the two groups(P>0.05).There was no statistically significant difference in intraoperative and postoperative dosage of norepinephrine and dobutamine between the two groups(P>0.05).There were significant differences in creatine kinase(CK),creatine kinase isoenzyme-MB(CK-MB),cardiac troponin I(cTnI),S100β protein and neuron-specific enolase(NSE)between the two groups at different time points(P<0.05).There was no statistically significant difference in the incidence of myocardial ischemic events,arrhythmia,cardiac rebeating,delirium rating scale(DRS-R-98) scores,delirium incidence,mini mental state examination(MMSE) and Montreal cognitive assessment(MOCA) scores between the two groups(P>0.05).Conclusions Sevoflurane preconditioning has a better protective effect on heart and brain function in patients undergoing cardiac valve replacement under CPB,without causing obvious differences in surgical progress and surgical outco

关 键 词：七氟烷 预处理 后处理 心脏瓣膜置换术 体外循环 心脑功能 保护作用 

分 类 号：R542.5[医药卫生—心血管疾病] R614.21[医药卫生—内科学]