两种麻醉方法对CPB心脏瓣膜置换术患者血浆S100β水平及其认知功能的影响

发布时间：2019-01-06 20:44

【摘要】：目的观察并比较七氟烷静吸复合麻醉与丙泊酚静脉麻醉对体外循环(CPB)下心脏瓣膜置换术患者血浆S100β蛋白水平和术后认知功能的影响。方法择期实施CPB下心脏瓣膜置换术的患者50例,随机分为七氟烷组与丙泊酚组,各25例。常规麻醉诱导后,七氟烷组采用七氟烷静吸复合麻醉,丙泊酚组采用丙泊酚静脉麻醉。采用脑电双频谱指数(BIS)监测。分别于CPB开始前(T1)、CPB结束后1 h(T2)、CPB结束后24 h(T3)、CPB结束后48 h(T4)抽取颈内静脉血测定血浆S100β蛋白;分别于术前、术后24 h采用简易精神状态检查量表(MMSE)评估认知功能。结果所有患者维持BIS值在40~65。两组T2时血浆S100β蛋白水平升高,T3时逐渐回落,T4时恢复基础值水平,且七氟烷组T2、T3时点血浆S100β蛋白水平低于丙泊酚组(P均0.05)。两组术后24 h MMSE评分低于术前,且七氟烷组术后24 h MMSE评分高于丙泊酚组(P均0.05)。结论七氟烷静吸复合麻醉及丙泊酚静脉麻醉均能满足CPB下心脏瓣膜置换手术的需要,但七氟烷静吸复合麻醉可降低CPB期间患者血浆S100β蛋白水平,对术后认知功能影响较小,更有利于保护脑功能。
[Abstract]:Objective to observe and compare the effects of sevoflurane combined anesthesia and propofol intravenous anesthesia on plasma S100 尾 protein level and postoperative cognitive function in patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB). Methods 50 patients undergoing cardiac valve replacement under CPB were randomly divided into sevoflurane group and propofol group. After induction of routine anesthesia, sevoflurane group was anesthetized with sevoflurane and propofol group with propofol intravenous anesthesia. Bispectral index (BIS) was used to monitor EEG. The plasma S100 尾 protein was measured before the start of CPB (1 h after T1), CPB (24 h after T2), CPB) (48 h after T3), CPB (T4). The cognitive function was evaluated by (MMSE) before and 24 hours after operation. Results all patients maintained a BIS value of 40 to 65. The level of S100 尾 protein increased at T2, decreased gradually at T3, and recovered to the basic level at T4. The level of S100 尾 protein in T2 and T3 in sevoflurane group was lower than that in propofol group (P 0.05). The MMSE score at 24 hours after operation in both groups was lower than that before operation, and the MMSE score in sevoflurane group at 24 hours after operation was higher than that in propofol group (all P 0. 05). Conclusion both sevoflurane combined anesthesia and propofol intravenous anesthesia can meet the needs of cardiac valve replacement under CPB. However, sevoflurane combined anesthesia can decrease the level of plasma S100 尾 protein in patients with CPB, and has little effect on postoperative cognitive function. More conducive to the protection of brain function.
【作者单位】：宜昌市中心人民医院;
【分类号】：R614.2

【参考文献】