CAJ | 학술논문

目的：探讨七氟烷对冠心病颅脑手术患者行控制性降血压的脑保护效应。方法冠心病颅脑手术患者26例,随机分为治疗组和对照组,各13例。所有患者在硬脑膜打开后开始行控制性降血压。对照组静脉泵注硝普钠为3~8μg·kg-1·min-1,治疗组复合吸入2%~5%七氟烷。记录患者围手术期血流动力学变化、手术医生满意度及患者住院时间。分别于手术前1 d、手术结束时及手术后1 d,检测患者血清肌钙蛋白1(TNI)、肌酸激酶同工酶(CK-MBM)、神经元特异性烯醇酶( NSE)和S100钙结合蛋白β( S-100β蛋白)浓度。结果治疗组和对照组手术后住院时间分别为(20.3±3.8),(23.9±4.6) d；与对照组比较,治疗组在控制性降血压期各时间点心率显著减低(均P<0.05),手术后1 d NSE、S-100β蛋白均显著降低(P<0.05),手术医生满意度显著提高(P<0.05)；与手术前1 d比较,手术结束时两组NSE、S-100β蛋白均显著升高(均P<0.05),手术后第1天TNI、CK-MBM、NSE、S-100β蛋白均显著升高(均P<0.05)。与手术结束时比较,对照组NSE、S-100β蛋白均显著升高(均P<0.05)。结论七氟烷对冠心病颅脑手术患者行控制性降血压不仅可有效保护脑组织,提高手术医生满意度,缩短患者住院时间,而且还能维持患者控制性降血压期间心肌的氧供需平衡；但不能防治冠心病患者手术后的心肌损伤。
목적：탐토칠불완대관심병로뇌수술환자행공제성강혈압적뇌보호효응。방법관심병로뇌수술환자26례,수궤분위치료조화대조조,각13례。소유환자재경뇌막타개후개시행공제성강혈압。대조조정맥빙주초보납위3~8μg·kg-1·min-1,치료조복합흡입2%~5%칠불완。기록환자위수술기혈류동역학변화、수술의생만의도급환자주원시간。분별우수술전1 d、수술결속시급수술후1 d,검측환자혈청기개단백1(TNI)、기산격매동공매(CK-MBM)、신경원특이성희순매( NSE)화S100개결합단백β( S-100β단백)농도。결과치료조화대조조수술후주원시간분별위(20.3±3.8),(23.9±4.6) d；여대조조비교,치료조재공제성강혈압기각시간점심솔현저감저(균P<0.05),수술후1 d NSE、S-100β단백균현저강저(P<0.05),수술의생만의도현저제고(P<0.05)；여수술전1 d비교,수술결속시량조NSE、S-100β단백균현저승고(균P<0.05),수술후제1천TNI、CK-MBM、NSE、S-100β단백균현저승고(균P<0.05)。여수술결속시비교,대조조NSE、S-100β단백균현저승고(균P<0.05)。결론칠불완대관심병로뇌수술환자행공제성강혈압불부가유효보호뇌조직,제고수술의생만의도,축단환자주원시간,이차환능유지환자공제성강혈압기간심기적양공수평형；단불능방치관심병환자수술후적심기손상。
Objective To study the neuroprotective effect of sevoflurane on controlled hypotension in patients with coronary heart disease undergoing craniocerebral surgery. Methods Twenty-six patients with coronary heart disease undergoing craniocerebral surgery were randomly divided into two groups,receiving either inhaled 2%-5%sevoflurane plus intravenous sodium nitroprusside (treatment group,n=13) or intravenous sodium nitroprusside 3-8 μg·kg-1 alone (contorl group,n=13) for blood pressure control. The hemodynamic changes were recorded during the operation. Patient satisfaction with surgeons and the duration hospital stay after surgery were recorded. The levels of cardiac troponin I (TNI),creatine kinase-MB (CK-MBM),neuron specific enolase ( NSE) and S100 calcium binding proteinβ( S-100βprotein) in serum were detected at one day pre-operation,the end of the operation,and one day post-operation. Results The duration of hospital stay after surgery was significantly shortened in treatment group [(20. 3±3. 8) versus (23. 9±4. 6) d,P<0. 05) compared with control group. The average heart rate significantly decreased, patient satisfaction significantly increased, and serum levels of NSE and S-100β protein one day post-operation significantly decreased as compared to control group (all P<0. 05). Compared with the day before operation,serum levels of NSE and S-100βprotein in the two groups increased significantly at the end of surgery (P<0. 05),and the levels of TNI,CK-MBM,NSE and S-100βsignificantly elevated one day post-operation (P<0. 05). Compared with the end of operation,serum levels of NSE and S-100βin contorl group incarcerated remarkably (P<0. 05) Conclusion Sevoflurane plays an important neuroprotective role,as evidenced by improving patients' satisfaction,reducing hospital stay after surgery,and maintaining the balance of myocardial oxygen delivery and consumption in craniocerebral surgery patients with coronary heart disease during controlled hypotension. However,it can not prevent postoperative myocardial injury in these patients.