异氟烷和丙泊酚对体外循环心内直视手术患者围术期脑保护作用的比较研究

Protective effects of propofol and isoflurane on cerebral oxygen metabolism and cerebral injury during cardiopulmonary bypass:A comparative study

目的:观察异氟烷和丙泊酚麻醉对体外循环(CPB)心内直视手术患者围术期脑氧供需平衡及脑损伤标记物S100β和神经元性烯醇化酶(NSE)蛋白浓度的影响。方法:将30例择期行体外循环瓣膜置换手术病人随机分为异氟烷组和丙泊酚组,分别于CPB开始前(T1)、鼻咽温降至稳定期(T2)、复温至36℃(T3)、CBP结束后30 min(T4)、CPB结束后6 h(T5)和CPB结束后24 h(T6)抽取桡动脉血和颈静脉球部血检测血气并测定颈内静脉血S100β和NSE蛋白的浓度。结果:CPB前两组患者颈内静脉球氧饱和度(SjvO2)、动脉-颈内静脉血氧含量差(Da-jvO2)、氧摄取率(CERO2)、脑损害标记物S100β及NSE蛋白浓度差异无统计学意义(P>0.05);随着降温逐渐加深,两组SjvO2升高,Da-jvO2和CERO2降低(P<0.05);复温开始后两组SjvO2较CPB前降低,而Da-jvO2、CERO2则升高(P<0.05);CPB开始后两组血浆S100β和NSE蛋白浓度逐渐升高,复温期达到峰值;S100β蛋白浓度在停机24 h后恢复至基础水平,NSE蛋白浓度仍略高于CPB前水平;两组各指标比较,丙泊酚组的变化幅度要明显低于异氟烷组。结论:两种麻醉方式均可满足CPB下瓣膜置换手术的需要,与异氟烷比较,丙泊酚麻醉更有利于CPB下患者脑氧代谢的改善和脑损伤的保护。

AIM： To observe the protective effects of isoflurane and propofol by the changes of cerebral oxygen supply-demands balance and serum concentration of S100β and NSE protein in cardiac valve replacement during cardiopulmonary bypass （CPB）. METHODS：All of 30 patients undergoing heart valve replacement were prospectively randomized divided into isoflurane group （with isotlurane adoption） and group （with propofol adoption ）, 15 cases for each group. Jugular venous bulb blood oxygen saturation （SjvO2）, Jugular arterial-venous oxygen content difference （Da-jvO2） and cerebral oxygen extraction rate （CERO2） and radical artery blood gas analysis were measured at six stages （T1 - T6 ） of CPB which include before CPB （T1）, bring down the temperature to stability stage （T2）, recovery temperature to 36℃ （T3）, 30min （ T4 ）, 6 hours （ T5 ） and 24 hours （ T6 ） after CPB. In addition, the jugular venous bulb blood was taken at the six time points to measure the blood concentration of S100β and NSE protein. RESULTS： Sjv-O2, Da-jvO2, CERO2 and the blood concentration of S100β and NSE protein which are brain damage markers were no significant difference （ P 〉 0.05 ） in two groups before CPB. SjvO2 in the two groups were both increased during cooling period and then decreased during rewarming period, but the change in propofol group is less than that in the isoflurane group （P 〈 0.01）. The blood concentrations of S100β protein and NSE protein were both increased after CPB, the concentration of protein in propofol group, however, were lower than in isoflurane group （ P 〈 0.05 ）. CONCLUSION： Two types of anesthesia can be used in valve replacement surgery under CPB. Compared with isoflurane, propofol anesthesia is more conducive to improvement cerebral oxygen of brain damage in cardiac metabolism and protection valve replacement surgery under CPB.