华中科技大学学报（医学版）
華中科技大學學報（醫學版）
화중과기대학학보（의학판）
ACTA UNIVERSITATIS MEDICINAE TONGJI
2015年
4期
484-487
,共4页
心肺转流术%丙泊酚%镇静深度%炎性反应
心肺轉流術%丙泊酚%鎮靜深度%炎性反應
심폐전류술%병박분%진정심도%염성반응
cardiopulmonary bypass%propofol%depth of sedation%inflammatory reaction
目的：探讨体外循环心脏瓣膜置换术患者丙泊酚镇静深度与炎性反应的关系。方法50例择期行心脏瓣膜置换术患者随机分成低脑电双频指数（BIS）组（30≤BIS值＜45）和高BIS组（45≤BIS值≤60），每组25例，两组患者麻醉诱导方法相同，麻醉维持：低BIS组和高BIS组分别采用7 mg／（kg · h）和3 mg／（kg · h）丙泊酚进行静脉输注，术中对丙泊酚输注速率进行调整以维持各组在相应的BIS值范围内。分别于麻醉诱导前（T0）、体外循环（CPB）结束时（T1）、术毕时（T2）和术后1 h（T3）采集颈内静脉球部血样6 mL ，利用ELISA酶联免疫吸附法检测血清IL‐6、TNF‐α和S100β蛋白浓度；分别于T0、T1、T2时采集动脉血，测定血pH值、血糖和乳酸浓度情况。结果 T1、T2和 T3时点，低BIS组患者血清IL‐6、TNF‐α浓度均低于高BIS组（均 P＜0.05），T2和T3时点，低BIS组患者血清S100β蛋白浓度均低于高BIS组（均 P＜0.05）；与高BIS组相比，低BIS组患者T1和T2时刻动脉血血糖和乳酸浓度均较低（均 P＜0.05）。结论适当加深镇静深度有助于减轻C PB下心脏瓣膜置换术患者炎性反应，有利于保护脑组织，减少脑损伤的发生。
目的：探討體外循環心髒瓣膜置換術患者丙泊酚鎮靜深度與炎性反應的關繫。方法50例擇期行心髒瓣膜置換術患者隨機分成低腦電雙頻指數（BIS）組（30≤BIS值＜45）和高BIS組（45≤BIS值≤60），每組25例，兩組患者痳醉誘導方法相同，痳醉維持：低BIS組和高BIS組分彆採用7 mg／（kg · h）和3 mg／（kg · h）丙泊酚進行靜脈輸註，術中對丙泊酚輸註速率進行調整以維持各組在相應的BIS值範圍內。分彆于痳醉誘導前（T0）、體外循環（CPB）結束時（T1）、術畢時（T2）和術後1 h（T3）採集頸內靜脈毬部血樣6 mL ，利用ELISA酶聯免疫吸附法檢測血清IL‐6、TNF‐α和S100β蛋白濃度；分彆于T0、T1、T2時採集動脈血，測定血pH值、血糖和乳痠濃度情況。結果 T1、T2和 T3時點，低BIS組患者血清IL‐6、TNF‐α濃度均低于高BIS組（均 P＜0.05），T2和T3時點，低BIS組患者血清S100β蛋白濃度均低于高BIS組（均 P＜0.05）；與高BIS組相比，低BIS組患者T1和T2時刻動脈血血糖和乳痠濃度均較低（均 P＜0.05）。結論適噹加深鎮靜深度有助于減輕C PB下心髒瓣膜置換術患者炎性反應，有利于保護腦組織，減少腦損傷的髮生。
목적：탐토체외순배심장판막치환술환자병박분진정심도여염성반응적관계。방법50례택기행심장판막치환술환자수궤분성저뇌전쌍빈지수（BIS）조（30≤BIS치＜45）화고BIS조（45≤BIS치≤60），매조25례，량조환자마취유도방법상동，마취유지：저BIS조화고BIS조분별채용7 mg／（kg · h）화3 mg／（kg · h）병박분진행정맥수주，술중대병박분수주속솔진행조정이유지각조재상응적BIS치범위내。분별우마취유도전（T0）、체외순배（CPB）결속시（T1）、술필시（T2）화술후1 h（T3）채집경내정맥구부혈양6 mL ，이용ELISA매련면역흡부법검측혈청IL‐6、TNF‐α화S100β단백농도；분별우T0、T1、T2시채집동맥혈，측정혈pH치、혈당화유산농도정황。결과 T1、T2화 T3시점，저BIS조환자혈청IL‐6、TNF‐α농도균저우고BIS조（균 P＜0.05），T2화T3시점，저BIS조환자혈청S100β단백농도균저우고BIS조（균 P＜0.05）；여고BIS조상비，저BIS조환자T1화T2시각동맥혈혈당화유산농도균교저（균 P＜0.05）。결론괄당가심진정심도유조우감경C PB하심장판막치환술환자염성반응，유리우보호뇌조직，감소뇌손상적발생。
Objective To investigate the relationship between inflammatory response and depth of propofol sedation during cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Fifty patients undergoing cardiac valve replacement with CPB were randomly divided into low Bispectral index (BIS)group(30≤BIS<45)and high BIS group(45≤BIS≤60).Each group had 25 cases.The induction of anesthesia in the two groups was in the same way.Anesthesia was maintained in the fol‐lowing way :low BIS group and high BIS group received intravenous infusion of 7 mg/(kg · h) and 3 mg/(kg · h) propofol ,re‐spectively.In operation ,the propofol infusion rate was adjusted to maintain each group in the corresponding BIS value range.Before induction of anesthesia(T0 ) ,at the end of the CPB(T1 ) ,the end of operation(T2 )and 1 h after operation(T3 ) ,re‐spectively ,6 mL of jugular vein blood samples were collected.The concentrations of IL‐6 ,TNF‐αand S100βprotein in the serum were detected by ELISA method.At T0 ,T1 and T2 ,respectively ,arterial blood was collected ,the pH of blood and the concentra‐tions of blood glucose and lactate were determined.Results At T1 ,T2 and T3 ,the concentrations of IL‐6 and TNF‐αin serum in low BIS group were all lower than those in the high BIS group(all P<0.05).At T2 and T3 ,the S100βprotein concentrations in serum in the low BIS group were all lower than those in the high BIS group (both P< 0.05).Compared with the high BIS group ,the concentrations of blood glucose and lactate in low group at T 1 and T2 were all lower(all P<0.05).Conclusion Ap‐propriately enhancing the depth of sedation could help relieve the inflammatory reaction of patients during cardiac valve replace‐ment with CPB.It can help protect brain tissue and reduce the incidence of brain injury.
