摘要
目的:观察异氟烷、丙泊酚、利多卡因合用丙泊酚在非体外循环下冠状动脉搭桥术(OPCABG)中对脑氧代谢的影响。方法:将择期行非体外循环下冠状动脉搭桥术的45例患者随机分为3组(每组15例),术中分别使用异氟烷(Ⅰ组)、丙泊酚(Ⅱ组)和利多卡因合用丙泊酚(Ⅲ组)维持。采用简易精神状态检查量表(MMSE)法于术前第1天和术后第3、7天评价患者神经精神功能状况;分别于切皮前、关胸时,术后6h和术后24h于颈内静脉球部、桡动脉抽取血样进行血气分析,测定颈内静脉血氧饱和度(SO2),计算出动脉血氧含量(CaO2)、颈内静脉血氧含量(CjvO2)、脑动-静脉血氧含量差(Ca-jvO2)及脑氧摄取率(CEO2)等指标。结果:术后第3天认知功能障碍(POCD)发生Ⅰ组较Ⅱ、Ⅲ组显著增高。3组患者随着手术开始颈内静脉血氧饱和度(SjvO2)均一过性下降,Ca-jvO2和CEO2呈升高趋势,术后逐渐恢复,至术后24h基本达到术前水平。术后24h时,Ⅱ、Ⅲ组的SjvO2值明显高于同时点Ⅰ组(P<0.05);Ⅱ、Ⅲ组Ca-jvO2值明显低于Ⅰ组(P<0.05),且Ⅲ组Ca-jvO2值低于同时期的Ⅱ组(P<0.05);Ⅲ组CEO2值明显低于Ⅰ组(P<0.05)。结论:与传统的吸入麻醉比较,术中靶控静脉输注丙泊酚或利多卡因联合丙泊酚能有效降低脑氧耗,对OPCABG术后早期脑氧供需障碍有一定的改善作用。
Objective： To investigate the effects of propofol and lidocaine-propofol on brain oxygen metabolism in patients undergoing coronary artery bypass graft （OPCABG）. Methods： Forty-five ASA Ⅱ - Ⅲ patients who have undergone elective OPCABG were randomly divided into three groups which included isoflurane group（ Ⅰ , n=15 ）, propofol group （ Ⅱ, n=15） and lidocaine-propofol group （Ⅲ, n=15）. Patients with neurological diseases were excluded. Internal jugular vein was canulated and the catheter was advanced retrogressly up to jugular bulb. The arterial and jugular oxygen content（CaO2） were monitored at different time points. The deviation of arterial-venous oxygen content （Ca-jvO2）, and the oxygen ingestion rate （CEO2） of the cerebrum were calculated. A battery of neutropsychological tests was performed and scored preoperatively and 3 and 7 days after surgery. Results： The incidence of POCD in group Ⅰ was higher than that in group Ⅱ and Ⅲ （P 〈 0.05）. SjvO2 temporarily decreased at the beginning of the surgery in three groups. Ca-jvO2 and CEO2 showed an increased trend, gradually recovered postoperatively, and got to the preoperative levels 24 hours after the surgery. SjvO2 in group Ⅱ and Ⅲ was higher than that in group Ⅰ 24 hours postoperatively （P 〈 0.05）. Ca-jvO2 in group Ⅱ and Ⅲ were lower than that in group Ⅰ （P 〈 0.05）, and it was lower in group Ⅲ than that in group Ⅱ （P 〈 0.05）. CEO2 in group Ⅲ was lower than that in group Ⅰ （P 〈 0.05 ）. Conclusion： The intraoperative intravenous infusion with proper dose of propofol or lidocaine and propofol can effectively decrease the oxygen exhaust compared with the traditional suctorial method. These have some protective effects on cognitive dysfunction in the early period after OPCABG.
出处
《天津医药》
CAS
北大核心
2009年第2期104-106,共3页
Tianjin Medical Journal
基金
天津市应用基础研究计划面上项目(项目编号:05YFJMJC12800)
