羟考酮对体外循环下瓣膜置换术患者的脑保护作用

Protective Effects of Oxycodone Preconditioning on Cerebral Injury in Cardiac Valve Replacement Patients with Cardiopulmonary Bypass

目的:探讨羟考酮预处理对体外循环（CPB）下瓣膜置换术患者的脑保护作用。方法:60例CPB下行瓣膜置换术患者随机分为4组（n=15）:对照组（C组）和不同剂量羟考酮组（Q1-Q3组）。Q1-Q3组于麻醉诱导前15min分别静脉注射羟考酮0.05,0.1及0.15mg/kg,C组以等容积生理盐水输注。于麻醉诱导前（T0）、CPB 30min（T1）、CPB结束时（T2）、CPB结束后12h（T3）、CPB结束后24h（T4）不同时刻分别取静脉血5ml,采用ELISA法测血浆S-100β蛋白浓度、神经元特异性烯醇酶（NSE）、丙二醛（MDA）、超氧化物歧化酶（SOD）浓度。结果:与T0时比较,T1-T4时各组血浆S-100β、NSE、MDA浓度升高,SOD浓度降低;与C组比较,在T1-T4时刻,Q1-Q3组血浆S-100β、NSE、MDA浓度降低,SOD浓度升高;与Q1组比较,在T1-T4时刻Q2和Q3组血浆S-100β、NSE、MDA浓度降低,SOD浓度升高。结论:羟考酮预处理可减轻CPB下瓣膜置换术患者的脑损伤,其机制可能与抑制脑脂质过氧化反应有关。

Objective:To evaluate the protective effects of oxycodone pyeconditioning against cerebral injury of patients undergoing cardiac valve replacement surgery with cardiopulmonary bypass（CPB）.Methods:Sixty patients undergoing cardiac valve replacement surgery were allocated randomly into 4 groups（n=15）:group C（Control group）and groups Q1-Q3（low,medium and high doses of oxycodone groups）.Patients in groups Q1-Q3 received an intravenous injection of oxycodone 0.05,0.1,or 0.15 mg/kg respectively at 15 min before anesthesia induction and those in group C received the same volume of normal saline.Blood samples were collected to determine the plasma concentrations of S-100βprotein,neuron specific enolas（NSE）,MDA,SOD（by enzyme-linked immunosorbent assay）at 5 min before anesthesia induction（T0）,30 min after initiation of CPB（T1）,the end of CPB（T2）,12 hafter CPB（T3）and 24 hafter CPB（T4）.Results:Plasma concentrations of S-100β,NSE and MDA were significantly higher while plasma SOD concentration was significantly lower at T1-T4,compared with the baseline values at T0 in above groups（P<0.05）.And similar differences were found in group Q2/Q3 versus group Q1 at timepoints T1-T4（all P<0.05）.Conclusion:Oxycodone preconditioning may attenuate brain injuryinduced by CPB in patients undergoing cardiac valve replacement surgery,and the mechanism is related to the inhibition of oxidative stress response.