天麻素注射液对二尖瓣置换术体外循环期间患者脑氧代谢的影响

Cerebral oxygen metabolic effect of gastrodin in patients undergoing replacement of mitral valve under cardiopulmonary bypass

目的观察天麻素注射液对体外循环期间患者脑氧代谢的影响。方法选择30例二尖瓣置换的患者,随机分为两组:试验组(n=15)和对照组(n=15)。两组患者均常规麻醉,同时试验组静脉滴注天麻素注射液(600mg),对照组静脉滴注生理盐水。分别于麻醉后CPB开始前鼻咽温为36℃时(T1)、CPB降温至28℃升主动脉阻断20min时(T2)、心脏复跳20min时(T3)采集桡动脉和颈内静脉球部的静脉血液进行血气分析,测量动脉血乳酸浓度(AL)和颈内静脉血乳酸浓度(VL),计算出动脉血氧含量(CaO2)、颈内静脉血氧含量(CjvO2)、动脉-颈内静脉血氧含量差(Ca-jvO2)及脑氧摄取率(CMRO2)。结果在T2时Ca-jvO2试验组明显低于对照组(P<0.01),试验组的CMRO2亦显著低于对照组(P<0.05);而AL及VL在T2时对照组的含量高于试验组(P<0.05)。结论天麻素能降低CPB中脑氧耗,有利于改善大脑氧供需平衡和保护CPB中缺血脑细胞的功能,可改善二尖瓣置换术患者CPB中的脑氧代谢。

Objective To investigated cerebral oxygen metabolism effect of gastrodin in patients undergoing replacement of mitral valve under Cardiopulmonary Bypass （CPB）. Methods 30 patients undergoing replacement of mitral valve were randomly divided into control group（n= 15） and experimental group（n= 15）. The gastrodin （600mg） was administered in the same time that patient was undergoing routine anaesthesia in experimental group. Saline was administered in the control group. Blood was collected from radial artery and jugular bulb venous for blood gas analysis, artery lactic acid concentration （ AL）, venous lactic acid concentration （VL） and the oxygen content of artery （ CaO2 ）, oxygen content of jugular venous（ CjvO2 ）, diference of oxygen content between artery and jugular venous （ Ca-jvO2 ） and cerebral metabolic rate for oxygen（ CMRO2 ） were calculated in different periods of CPB. Results Both Ca-jrO2（P〈0. 01 ） and CMRO2（P〈0. 05） were significantly lower in experiment group than those in control group during CPB. Both AL and VL were significantly lower in experiment group than those in control group during CPB respectively （P〈0. 05）. Conclusion The gastredin can degrade cerebral metabolic rate for oxygen and protect cerebral function and improve the balance of cerebral oxygen metabolism in patients undergoing replacement of mitral valve under CPB.