七氟醚对心脏瓣膜置换术患者rSO_2和术后认知功能的影响

Effects of sevoflurane on regional cerebral oxygen saturation and postoperative cognitive function in patients undergoing cardiac valve replacement

目的:观察心肺转流期间吸入不同浓度的七氟醚对单瓣膜置换术患者局部脑氧饱和度(regional cerebral oxygen saturation,rSO_2)和术后认知功能的影响。方法:将42例拟择期行单瓣膜置换术患者随机分为3组,每组14例。心肺转流期间对照组静脉微泵输注丙泊酚4~6 mg·kg^(-1)·h^(-1);静吸复合组静脉微泵输注丙泊酚2~3 mg·kg^(-1)·h^(-1),同时经膜式氧合器吸入0.5最低肺泡有效浓度(MAC)七氟醚;七氟醚组经膜式氧合器吸入1~1.5 MAC七氟醚。分别于麻醉诱导前(T_1)、主动脉阻断后5 min(T_2)、心肺转流30 min(T_3)和停机后30 min(T_4)共4个时点记录rSO_2。于术前1 d和术后7 d通过神经心理学测试评估患者认知功能。记录术后气管导管拔管时间和ICU停留时间。结果:与对照组比较,复合组与七氟醚组在T_3、T_4时点rSO_2均明显升高(P<0.05)。3组患者术后认知功能障碍发生率、术后气管导管拔管时间和ICU停留时间比较无明显差异(P>0.05)。结论:心肺转流期间吸入一定浓度七氟醚可提高rSO_2,但对术后认知功能影响不明显。

Objective：To observe the effects of sevoflurane inhalation during cardiopulmonary bypass （CPB）on regional cerebral oxygen saturation（rSO2 ）and postoperative cognitive function in patients under-going single valve replacement.Methods：Forty-two patients scheduled for single valve replacement under CPB,were randomly divided into 3 groups（n =14 each）.During CPB,the anesthesia was maintained with propofol 4 ~6 mg·kg -1 ·h -1 continuous infusion in the control group;the anesthesia was maintained with propofol 2 ~3 mg·kg -1 ·h -1 continuous infusion,and with 0.5 minimum alveolar concentration（MAC） sevoflurane inhalation via the membrane oxygenator in the combination group;the anesthesia was maintained with 1 ~1.5 MAC sevoflurane inhalation via the membrane oxygenator in the sevoflurane group.rSO2 was recorded before anesthesia induction（T1 ）,5 min after clamping the aorta（T2 ）,30 min after the beginning of CPB（T3 ）,30 min after the termination of CPB（T4 ）.The cognitive function was evaluated by neuropsy-chological tests at 1 day before surgery and 7 day after surgery.Extubation time and ICU staying length were also recorded.Results：Compared with control group,rSO2 was significantly increased at T3 ,T4 in both com-bination group and sevoflurane group（P 〈0.05）.There was no statistical significance in the incidence of postoperative cognitive dysfunction and extubation time and ICU staying length between the three groups （P 〉0.05）.Conclusion：Sevoflurane inhalation during CPB can increase rSO2 ,but it has no significant impact on the incidence of postoperative cognitive dysfunction.