体外循环心脏直视手术期间天麻素对患者脑血流量/脑氧耗比值的影响

Effect of gastrodin on CBF/CMRO_2 in patients undergoing open-heart surgery with cardiopulmonary bypass

目的观察体外循环心脏直视手术期间天麻素对患者脑血流量/脑氧耗的影响,并探讨其在体外循环心脏直视术期间的脑保护作用。方法选择择期在中低温心脏停跳CPB下二尖瓣置换的患者30例,随机分为试验组和对照组,每组各15例。两组患者采用统一的麻醉方案和体外循环方法,试验组在CPB前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鼻咽温为36℃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,测量颈静脉球部血氧饱和度(SjvO2),计算动脉血氧含量(CaO2)、脑氧摄取率(CERO2)。结果组内比较,CERO2:T2时与T1比较两组均显著降低(P<0.01),T3时较T2回升(P<0.01);脑血流量/脑氧耗比值(CBF/CMRO2):对照组和试验组T2与T1比较差异均存在统计学意义(P<0.05)。组间比较,CERO2:T2、T3时试验组均显著低于对照组(P<0.01);CBF/CMRO2:T2时试验组明显低于对照组(P<0.05)。结论 CPB中天麻素能降低脑氧耗,有利于改善大脑氧供需平衡。

Objective To observe the effect of Gastrodin on CBF/CMRO2 in patients undergoing open-heart surgery with cardiopulmonary bypass（CPB）.To discuss the effect and the mechanism of Gastrodin on cerebral injury undergoing CPB.Methods 30 patients（ASA physical status Ⅱto Ⅲ） 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 and blood lactic acid,measure and calculate the jugular bulb oxygen saturation（SjvO2）,arterial oxygen content（CaO2）,cerebral oxygen extraction rate（CERO2）before CPB（T1）,the nose temperature drop to constant temperature regularly to 28℃（T2）,and 20 minute after heart beating（T3）.Results Two groups all stepped up at T2 compared with T1,stepped down at T3 compared with T2.By group comparison,CBF/ CMRO2 of experimental group was significantly higher than that of another group at T2（P0.05）.Conclusion Undergoing CPB,Gastrodin could reduce cerebral oxygen consumption,would help to improve brain oxygen supply and demand balance,improve cerebral oxygen metabolism,reduce brain lactate production.