盐酸戊乙奎醚对心肺转流心瓣膜置换术患者脑氧代谢功能的影响

Effects of penehyclidine hydrochloride on cerebral oxygen metabolism in patients undergoing cardiac valve replacement with CPB

目的观察盐酸戊乙奎醚对心肺转流（CPB）心瓣膜置换术脑氧代谢功能的影响。方法60例行心瓣膜置换术患者，随机均分为三组：麻醉诱导后Ⅰ组、Ⅱ组分别静脉注射盐酸戊乙奎醚0．04mg／kg和0．02mg／kg，UI组注射等容量生理盐水。采集诱导后即刻（T1）、阻断升主动脉前（T2）、心脏复跳后（T3）、停止CPB（T1）及术毕（T5）桡动脉及颈静脉球部血样行血气分析，记录并计算颈内动脉、静脉乳酸含量及差值（Laca、Lacjv、Laca-jv）、血氧分压及差值（PaO2、PjvO2、PajvO2）、二氧化碳分压及差值（PaCO2、PjvCO2、Pa—jvCO2）、血氧饱和度及差值（SaO2、SjvO2、Sa-jvO2）、颈内动脉、静脉血氧含量及差值（CaO2、qvO2、Ca-jvO2）及脑氧摄取率（CEO2）。结果与T1时比较，T3～T5时三组Lacjv、Laca-jv均增高，5T时三组Pa-jvO2增高（P〈0．05）。I组的Lacjv、Laca—jv低于Ⅱ组和Ⅲ组，而SjvO2、Sa-jvO2高于Ⅱ组和Ⅲ组（P〈0．05）；T3～R时Ⅱ组Lacjv、Laca-jv低于Ⅲ组（P〈0．05）。T4、T5时Ⅲ组Pa-jvO2低于T组和Ⅱ组（P〈0．05）。与T1时比较，T3～T5时三组CaO2、Cj—vO2、CEO2值均明显降低（P〈0．05）。T3～T5时I组Ca-jvO2、CEO2高于Ⅱ组、Ⅲ组（P〈0．05）。结论盐酸戊乙奎醚可有效提高CEO2，增加脑组织氧含量并促进脑能量代谢，对脑组织氧供需平衡的维护起到积极作用。

Objective To observe the effects of penehyclidine hydrochloride on cerebral oxygen metabolism in patients undergoing cardiac valve replacement with CPB. Methods Sixty patients undergoing elective cardiac valve replacement with CPB were equally randomized into three groups. After induction of anesthesia, groups Ⅰ and Ⅱ received penehyclidine hydrochloride 0.04 mg/kg and 0. 02 mg/kg respectively, group Ⅲ received the equal volume of normal saline. Blood samples were taken from radial artery and internal jugular bulb to determine Laca. Lacjv. I.aca-jv. PaO2, PjvO2, Pa- jvO2 ,PaCe2 ,PjvCO2, Pa-jvCO2, SaO2, SjvO2, Sa-jvO2, et al, after induction （T1）, before ascending aorta clamped （T2）, after heart resuscitation （T3）, at the termination of CPB （T4） and at the end of the operation （T5）. Results Comparing to T1, Lacjv, Laca-jv and Sa-jvO2 increased while SjvO2 deereased in all groups at T3-T5. Pa-jvO2 increased at T5 （P〈0.05）. Lacjv and I.aca-jv were lower while SjvO2, Sa-jvO2 were higher in group Ⅰ than in groups Ⅱ and Ⅲ （P〈0. 05）. Lacjv and Laca-jv in group Ⅱ were lower than group Ⅲ. Pa-jvO2 is lower in group Ⅲthan in group Ⅰ and Ⅱ at T4 ,T5. Comparing to T1 ,CaO2, CjvO2 and CEO2 decreased at T3- T5 in each group （P〈0. 05）. Ca jvO2, CEO2 is higher in group I than in groups Ⅱand Ⅲ at T3- T5 （P〈0.05）. Conclusion Penehyclidine hydrochloride can improve CEO2 effectively and increase oxygen content and brain energy metabolism. It has nositive effects on maintaining the balance of cerebral oxygen supply consumption.