七氟烷对心脏瓣膜置换术后患者神经认知功能的影响  

Effect of sevoflurane on neurocognitive function of patients after cardiac valve replacement

作　　者：邓龙生[1] 纪月珑[1] 李向南 钱静[1] 袁从虎[1] 于广东[1] DENG Longsheng;JI Yuelong;LI Xiangnan;QIAN Jing;YUAN Conghu;YU Guangdong(Department of Anesthesia,Yancheng Third People′s Hospital,Yancheng Jiangsu 224000,China)

机构地区：[1]盐城市第三人民医院麻醉科,江苏盐城224000

出　　处：《新疆医科大学学报》2023年第2期210-214,共5页Journal of Xinjiang Medical University

基　　金：江苏省软科学研究计划项目(183920932)。

摘　　要：目的探讨七氟烷对心脏瓣膜置换术后患者神经认知功能的影响。方法选择2016年1月-2022年7月盐城市第三人民医院收治的148例行心脏瓣膜置换术患者,按随机数字表法分为观察组和对照组,各74例。所有患者均进行全麻。观察组于动脉开放前2 min,从体外肺转流机的人工肺吹入2%七氟烷,持续20 min。维持麻醉方式同对照组。记录两组患者手术时间、主动脉阻断时间、体外循环时间、术中循环失代偿、术后苏醒时间、拔管时间、ICU停留时间。术前及术后3、7 d时对所有患者进行简易精神状态检查(Mini-mental state examination,MMSE)评分。术前、术后3 d及术后7 d时对所有患者采用酶联免疫吸附实验检测血清中神经元特异性烯醇化酶(Neuron-specific enolase,NSE)、中枢神经特异蛋白S100-β、白细胞介素6(Interleukin 6,IL-6)和肿瘤坏死因子α(Tumor necrosis factorα,TNF-α)水平;检测颈内静脉氧饱和度(Jugular venous oxygen saturation,SjvO_(2))、动脉-颈内静脉血氧含量差(Arterial internal jugular vein bulbar oxygen difference,Da-jvO_(2))、脑氧摄入率(Cerebral oxygen intake rate,CE-RO_(2))。结果两组患者手术时间、主动脉阻断时间、体外循环时间、术中循环失代偿发生率比较差异无统计学意义(P>0.05)。观察组术后苏醒时间、拔管时间、ICU停留时间均低于对照组(P<0.05)。术前两组患者MMSE评分比较差异无统计学意义(P>0.05),术后3 d和术后7d观察组MSSE评分均高于对照组(P<0.05)。术后3 d观察组NSE、S-100β、IL-6、TNF-α水平均低于对照组(P<0.05);术后7 d两组患者NSE、S-100β、IL-6、TNF-α水平比较差异无统计学意义(P>0.05)。术后3 d和术后7 d观察组SjvO_(2)均高于对照组,而Da-jvO_(2)、CE-RO_(2)低于对照组(P<0.05)。结论七氟烷会促进心脏瓣膜置换术后患者神经认知功能的恢复。ObjectiveTo explore the effect of sevoflurane on neurocognitive function of the patients after cardiac valve replacement.MethodsSelect 148 patients undergoing heart valve replacement surgery in the hospital from January 2016 to July 2022,and the patientsrandomly divide into observation group and control group,with 74 cases in each group.All patients underwent general anesthesia.In the observation group,2%sevoflurane was injected from the artificial lung of extracorporeal lung bypass machine 2 minutes before the opening of artery for 20 minutes.The way of maintaining anesthesia was the same as that of the control group.The operation time,aortic block time,extracorporeal circulation time,intraoperative circulation decompensation,postoperative recovery time,extubation timeand ICU stay time were recorded.All patients were scored by the Mini Mental State Examination(MMSE)before and 3d and 7d after the operation.Enzyme-linked immunosorbent assay was used to detect serum levels of NSE,S-100β,IL-6,and TNF-αbefore the operation,3 daysand 7 days after the operation;to detect internal jugular vein oxygen saturation(SjvO_(2)),artery-internal jugular vein Poor blood oxygen content(arterial internal jugular vein bulbar oxygen difference,Da-jvO_(2))and cerebral oxygen intake rate(CE-RO_(2)).ResultsThere was no statistical difference between the two groups in operation time,aortic block time,extracorporeal circulation time and incidence of intraoperative circulation decompensation(P>0.05).The postoperative recovery time,extubation time and ICU stay time of the observation group were lower than those of the control group(P<0.05).There was no significant difference in MMSE scores between the two groups before the surgery(P>0.05).The MMSE scores of the observation group were higher than those of the control group at 3d and 7d after the surgery(P<0.05).The levels of NSE,S-100β,IL-6and TNF-αin the observation group were lower than those in the control group(P<0.05);the levels of NSE,S-100β,IL-6and TNF-αin the two groups on the

关 键 词：七氟烷 麻醉 心脏瓣膜置换术 神经认知功能 

分 类 号：R614.2[医药卫生—麻醉学]