七氟醚旁路洗入对体外循环心脏瓣膜置换术患者脑损伤的影响

Effect of sevoflurane bypass wash-in on brain injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass

目的 评价七氟醚旁路洗入对体外循环（CPB）下心脏瓣膜置换术患者脑损伤的影响.方法 择期行CPB下心脏瓣膜置换术患者60例,性别不限,年龄24～67岁,体质指数16.7～27.3 kg/m2,采用随机数字表法,分为两组（每组n=30）：对照组（C组）和七氟醚组（S组）.S组于CPB期间通过体外循环机旁路洗入1.0％～3.0％七氟醚,C组不做任何处理.于CPB前（T0）、降温至28℃（T1）、复温至37℃（T2）、停CPB（T3）和术毕（T4）时采集颈内静脉球部和桡动脉血样,进行血气分析,测定颈内静脉球部血氧饱和度（SjvO2）,计算动脉—静脉血氧含量差（Da-jvO2）和脑氧摄取率（CEO2）,并测定颈内静脉球部血浆S-100β蛋白和8-异前列腺素—F2α（8—iso-PGF2α）浓度.结果 与C组比较,S组T1～T4时点颈内静脉球部血浆S-100β蛋白和8—iso-PGF2α浓度降低（P＜0.05）,T1～T3时点SjvO2升高,Da-jvO2和CEO2下降（P＜0.05）.结论 七氟醚旁路洗入可减轻CPB下心脏瓣膜置换术患者脑损伤,其机制与抑制脂质过氧化反应和降低脑氧代谢率有关.

Objective To investigate the effect of sevoflurane bypass wash--in on brain injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass （CPB）. Methods Sixty patients （males and females） aged 24-67 yr, with body mass index of 16.7-27.3 kg/m2 , and undergoing selective cardiac valve replacement with CPB were randomly divided into 2 groups： a control group （group C, n -30） and a sevoflurane group （group S, n =30 ）. 1.0%-3.0% Sevoflurane was washed into the extracorporeal circuit during CPB in group S. No management during CPB was done for group C. At time points before CPB （base- line, T0）, when naso--pharyngeal temperature was down--regulated at 28 ℃ （T1）, when naso--pharyngeal temperature was restored at 37 ℃ （T2） and at the end of CPB （Wa） and post--operation （T4）, radial arterial and jugular bulb venous blood samples were collected for blood gas analysis, and jugular vein oxygen saturation （SjvO2） were determined, arterial venous oxygen content differences （Da-jvO2） and cerebral oxygen extrac- tion rate （CEO2） were calculated, and the concentration of the jugular bulb venous S-10013 protein and 8-iso -PGF2α were determined. Results Compared to group C, group S had significantly lower jugular bulb ve nous plasma concentrations of S-10013 protein and 8-iso-PGF2α at time points T1 -T4 （ P 〈0.05）. SjvO2 was significantly elevated, Da-jvO2 and CEO2 were significantly reduced at T1 -T3 in group S, compared to group C, there were statistically significant differences （ P 〈0.05）. Conclusion Sevoflurane bypass washin can reduce the brain injury in patients undergoing cardiac valve replacement with CPB, and its mechanism was related with inhibiting lipid peroxidation and decreasing cerebral oxygen metabolic rate.