CPB期间吸入七氟烷对心脏瓣膜置换术患者术后早期脑损伤的影响  

Effect of inhalation of sevoflurane during cardiopulmonary bypass on early postoperative brain injury in patients undergoing cardiac valve replacement

作　　者：赵雅梅[1] 史宏伟[1] 魏海燕[1] 葛亚力[1] 王振红[1] 施韬[1] 肖立琼[2] Zhao Yamei;Shi Hongwei;Wei Haiyan;Ge Yali;Wang Zhenhong;Shi Tao;Xiao Liqiong(Department of Anesthesiology,Nanjing Hospital Affiliated to Nanjing Medical University(Nanjing First Hospital),Nanjing 210006,China;Department of Thoracic and Cardiovascular Surgery,Nanjing Hospital Affiliated to Nanjing Medical University(Nanjing First Hospital),Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)麻醉科,南京210006 [2]南京医科大学附属南京医院(南京市第一医院)胸心血管外科体外循环组,南京210006

出　　处：《中华麻醉学杂志》2022年第5期539-541,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价CPB期间吸入七氟烷对心脏瓣膜置换术患者术后早期脑损伤的影响。方法择期行CPB单瓣膜置换术的风湿性心脏病患者42例,性别不限,年龄40~70岁,体重47~86 kg,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为3组(n=14):对照组(C组)、静吸复合麻醉组(CA组)和七氟烷组(S组)。CPB期间,C组静脉泵注丙泊酚4~6 mg·kg^(-1)·h^(-1),CA组静脉泵注丙泊酚2~3 mg·kg^(-1)·h^(-1),同时经膜式氧合器吸入0.5 MAC七氟烷,S组CPB经膜式氧合器吸入(1.0~1.5)MAC七氟烷。3组术中均维持麻醉镇静指数值40~60。于麻醉诱导前(T_(1))、停CPB后30 min(T_(2))、停CPB后6 h(T_(3))和24 h(T_(4))时取动脉血样,采用ELISA法测定血浆NSE和Tau蛋白浓度。结果与C组相比,S组T_(2,3)时血浆NSE浓度和T_(2~4)时血浆Tau蛋白浓度降低,CA组T_(2)时血浆Tau蛋白浓度降低(P<0.05);与CA组相比,S组T_(2,3)时血浆NSE浓度和T_(2~4)时血浆Tau蛋白浓度降低(P<0.05)。结论CPB期间吸入七氟烷可在一定程度上减轻CPB心脏瓣膜置换术患者术后早期脑损伤。Objective To evaluate the effect of inhalation of sevoflurane during cardiopulmonary bypass(CPB)on early postoperative brain injury in the patients undergoing cardiac valve replacement.Methods Forty-two American Society of Anesthesiaologists physical statusⅡorⅢpatients of either sex,aged 40-70 yr,weighing 47-86 kg,scheduled for elective single valve replacement under CPB,were divided into 3 groups(n=14 each)using a random number table method:control group(group C),combined intravenous-inhalational anesthesia group(group CA)and sevoflurane group(group S).During CPB,propofol 4-6 mg·kg^(-1)·h^(-1) was intravenously infused in group C,propofol 2-3 mg·kg^(-1)·h^(-1) was intravenously infused,and 0.5 MAC sevoflurane was inhaled via the membrane oxygenator in group CA,and 1.0-1.5 MAC sevoflurane was inhaled via the membrane oxygenator in group S.The anesthesia and sedation index values were maintained at 40-60 during operation in the three groups.Blood samples were taken from arteries before anesthesia induction(T_(1)),at 30 min and 6 and 24 h after termination of CPB(T_(2~4))for determination of plasma concentrations of neuron-specific enolase(NSE)and Tau protein.Results Compared with group C,the plasma concentration of NSE was significantly decreased at T_(2,3),and plasma concentration of Tau protein was decreased at T_(2~4)in group S,and the plasma concentration of Tau protein was decreased at T_(2)in group CA(P<0.05).Compared with group CA,the plasma concentration of NSE was significantly decreased at T_(2,3),and the plasma concentration of Tau protein was decreased at T_(2~4)in group S(P<0.05).Conclusions Inhalation of sevoflurane during CPB can reduce early postoperative brain injury to a certain extent in the patients undergoing cardiac valve replacement.

关 键 词：麻醉药 吸入 心肺转流术 心脏瓣膜假体植入 脑损伤 

分 类 号：R614[医药卫生—麻醉学]