七氟醚对CPB下心脏瓣膜置换术患者心脑保护作用及氧化应激反应的影响

Effect of sevoflurane administration on the cardio-cerebral protection and oxidative stress in patients undergoing heart valve replacement under CPB

【目的】探讨七氟醚给药对体外循环(cardiopulmonary bypass,CPB)下心脏瓣膜置换术患者心脑保护作用及氧化应激反应的影响。【方法】选取在医院心脏外科手术室择期进行CPB下心脏瓣膜置换术的96例患者,按照随机数字表法将其分为对照组48例和观察组48例。观察组患者于麻醉诱导后吸入1.2最低肺泡有效浓度(MAC)的七氟醚,对照组患者以等量生理盐水代替七氟醚。比较2组麻醉诱导前(T0)、切皮时(T1)、CPB后10 min(T2)、CPB停机后1 h(T3)及术毕(T4)5个时间点的桡动脉血氧含量(CaO2)、颈内静脉血氧饱和度(SjvO2)、动脉-静脉血氧含量差(Da-jvO2),血清肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白Ⅰ(cTnⅠ)、心型脂肪酸结合蛋白(H-FABP)、神经元特异性烯醇化酶(NSE)、星形胶质源性蛋白(S-100β)、丙二醛(MDA)、超氧化物歧化酶(SOD)、核因子相关因子-2(Nrf-2)mRNA水平,术前及术后3 d的简易精神状态检查表(MMSE)评分。【结果】T2时2组SjvO2明显高于T0时,CaO2、Da-jvO2明显低于T0时(P<0.05),T1时观察组CaO2、Da-jvO2明显低于T0时(P<0.05);T1、T2时,观察组SjvO2均高于对照组,CaO2、Da-jvO2均低于对照组(P<0.05)。T1-T4时,2组血清CK-MB、cTnI、H-FABP、NSE、S-100β、MDA、SOD、Nrf-2 mRNA水平均明显高于T0时(P<0.05),且观察组均明显低于对照组(P<0.05)。术后3 d,对照组MMSE评分明显低于术前(P<0.05),且观察组明显高于对照组(P<0.05)。【结论】七氟醚的应用可对CPB下心脏瓣膜置换术患者心肌及脑部起到保护作用,并可能减轻氧化应激反应。

【Objective】To explore the effect of sevoflurane administration on the cardio-cerebral protection and oxidative stress in patients undergoing heart valve replacement under cardiopulmonary bypass(CPB).[Methods]A total of 96 patients who underwent valve replacement under CPB in our cardiac surgery room were selected and randomly divided into control group(48 cases)and observation group(48 cases).The patients in the observation group inhaled 1.2 minimum alveolar effective concentration(MAC)of sevoflurane after anesthesia induction,while sevoflurane was replaced by the same amount of normal saline in the control group.Radial arterial oxygen content(CaO2),blood oxygen saturation of internal jugular vein(SjvO2),arterial-venous oxygen content difference(Da-jvO2)and the levels of serum creatine kinase isoenzyme(CK-MB),cardiac troponinⅠ(cTnⅠ),heart-type fatty acid binding protein(H-FABP),neuron specific enolase(NSE),astrogenic protein(S-100β),malondialdehyde(MDA),superoxide dismutase(SOD)and nuclear factor-2(Nrf-2)mRNA were compared between the two groups at 5 time points as follows,before anesthesia induction(T0),at the time of skin cutting(T1),10 minutes after CPB(T2),1 hour after CPB shutdown(T3)and at the end of operation(T4).And mini-mental state examination(MMSE)score was carried out before operation and 3 days after operation.【Results】At T2,SjvO2 in both groups was significantly higher than that at T0,while CaO2 and Da-jvO2 were significantly lower than those at T0(P<0.05).At T1,CaO2 and Da-jvO2 in the observation group were significantly lower than those at T0(P<0.05).At T1 and T2,SjvO2 in the observation group was higher than that in the control group,and CaO2 and Da-jvO2 were lower than those in the control group(P<0.05).The levels of CK-MB,cTnⅠ,H-FABP,NSE,S-100β,MDA,SOD and Nrf-2 mRNA in both groups from T1 to T4 were significantly higher than those in T0(P<0.05),and those in the observation group were significantly lower than those in the control group(P<0.05).The MMSE score in the control group 3 days after operation was significantly lower than that before operation(P<0.05),and the score in the observation group was significantly higher than that in the control group(P<0.05).【Conclusion】Sevoflurane can protect the myocardium and brain in patients undergoing heart valve replacement under CPB,and reduce oxidative stress.