丙泊酚或七氟醚复合舒芬太尼麻醉对CPB下瓣膜手术患者脑保护效应的比较

Cerebral protective effect of propofol versus sevoflurane combined with sufentanil anesthesia in patients undergoing valvular surgery under cardiopulmonary bypass

目的比较丙泊酚或七氟醚复合舒芬太尼麻醉对CPB下瓣膜手术患者的脑保护效应。方法择期CPB下行瓣膜手术患者60例，年龄60～70岁，ASA分级Ⅱ或Ⅲ级。采用随机数字表法分为丙泊酚复合麻醉组（PA组）和七氟醚复合麻醉组（SA组），每组30例。自麻醉诱导至术毕PA组持续靶控输注丙泊酚0．5—2．0μg／ml；SA组持续吸入0．5％～2．5％七氟醚，维持BIS值45—55。分别于麻醉诱导后即刻（T0）、术毕（T1）、术后6、12和24h（T2-4）时上腔静脉逆行置管抽取血样，采用ELISA法测定血浆S-100β蛋白和神经元特异性烯醇化酶（NSE）的浓度。结果与sA组比较，PA组T1,2时血浆S-100β蛋白浓度、T1-3时NSE浓度降低（P〈0．05）。结论丙泊酚复合舒芬太尼麻醉对CPB下瓣膜手术患者的脑保护效应优于七氟醚复合舒芬太尼麻醉。

Objective To compare the cerebral protective effect of propofol and sevoflurane combined with sufentanil anesthesia in the patients undergoing valvular surgery under cardiopulmonary bypass （CPB）. Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 60-70 yr, scheduled for elective valvular surgery under CPB, were randomly divided into either propofol-based anesthesia group （group PA） or sevoflurane-based anesthesia group （group SA） , with 30 patients in each group. From induction of anesthesia to the end of surgery, group P received target- controlled infusion of propofol 0.5-2.0 μg/ml, and group S continuously inhaled 0.5%-2.5% sevoflurane. Bispectral index value was maintained at 45-55. Immediately after induction （T0） , at the end of surgery （T1 ） , and at 6, 12 and 24 h after surgery （T2-4） , the superior vena cava was retrogradely cannulated for blood sampling, and the concentrations of plasma S-100β protein and neuron-specific enzyme were determined using enzyme-linked immunosorbent assay. Results Compared with group SA, the plasma S- 100β concentrations at T1,2 and neuron-specific enzyme concentrations at T1-3 were significantly decreased in group PA. Conclusion The cerebral protective effect of propofol combined with sufentanil anesthesia is superior to that of sevoflurane combined with sufentanil anesthesia in the patients undergoing valvular surgery under CPB.