CAJ | 학술논문

目的评价盐酸戊乙奎醚复合乌司他丁对CPB下心脏瓣膜置换术患者脑损伤的影响.方法择期CPB下行心脏瓣膜置换术患者48例,年龄20～ 64岁,体重40～66 kg,ASA分级Ⅱ级,心功能分级Ⅱ级.采用随机数字表法分为4组(n=12):对照组(C组)、盐酸戊乙奎醚组(P组)、乌司他丁组(U组)和盐酸戊乙奎醚复合乌司他丁组(PU组).P组于麻醉诱导前15 min右颈内静脉注射盐酸戊乙奎醚0.02 mg/kg,U组乌司他丁总量为2× 104 U/kg,麻醉诱导后手术前右颈内静脉注射总量的30％,CPB机预充液中加入总量的40％,开放升主动脉时右颈内静脉注射总量的30％,PU组盐酸戊乙奎醚和乌司他丁给药同P组与U组,C组给予等容量生理盐水.于麻醉诱导后手术前(T1)、CPB 30 min(T2)、CPB结束后30 min(T3)和6 h(T4)时采集左颈内静脉球部血样、桡动脉血样,行血气分析,测定颈静脉球血氧饱和度、颈静脉球血氧含量、动脉血氧含量,计算动脉-颈静脉球血氧含量差(Ca-jvO2)和脑氧摄取率(CERO2);采用ELISA法测定血浆S-100β蛋白和神经元特异性烯醇化酶(NSE)的浓度.结果与C组比较,P组、U组T2.3时和PU组T2.4时SjvO2升高,CERO2降低,P组、U组和PU组T23时Ca-jvO2、血浆S-100β蛋白及NSE浓度降低(P＜0.01);与P组和U组比较,PU组T23时血浆S-100β蛋白及NSE浓度降低(P＜0.01).结论盐酸戊乙奎醚复合乌司他丁减轻CPB下心脏瓣膜置换术患者脑损伤的效果优于单独应用.
목적 평개염산무을규미복합오사타정대CPB하심장판막치환술환자뇌손상적영향.방법 택기CPB하행심장판막치환술환자48례,년령20～ 64세,체중40～66 kg,ASA분급Ⅱ급,심공능분급Ⅱ급.채용수궤수자표법분위4조(n=12):대조조(C조)、염산무을규미조(P조)、오사타정조(U조)화염산무을규미복합오사타정조(PU조).P조우마취유도전15 min우경내정맥주사염산무을규미0.02 mg/kg,U조오사타정총량위2× 104 U/kg,마취유도후수술전우경내정맥주사총량적30％,CPB궤예충액중가입총량적40％,개방승주동맥시우경내정맥주사총량적30％,PU조염산무을규미화오사타정급약동P조여U조,C조급여등용량생리염수.우마취유도후수술전(T1)、CPB 30 min(T2)、CPB결속후30 min(T3)화6 h(T4)시채집좌경내정맥구부혈양、뇨동맥혈양,행혈기분석,측정경정맥구혈양포화도、경정맥구혈양함량、동맥혈양함량,계산동맥-경정맥구혈양함량차(Ca-jvO2)화뇌양섭취솔(CERO2);채용ELISA법측정혈장S-100β단백화신경원특이성희순화매(NSE)적농도.결과 여C조비교,P조、U조T2.3시화PU조T2.4시SjvO2승고,CERO2강저,P조、U조화PU조T23시Ca-jvO2、혈장S-100β단백급NSE농도강저(P＜0.01);여P조화U조비교,PU조T23시혈장S-100β단백급NSE농도강저(P＜0.01).결론 염산무을규미복합오사타정감경CPB하심장판막치환술환자뇌손상적효과우우단독응용.
Objective To evaluate the effects of penehyclidine hydrochloride combined with ulinastatin on brain injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Forty-eight patients of both sexes,aged 20-64 yr,weighing 40-66 kg,of ASA physical status Ⅱ (NYHA Ⅱ),scheduled for elective cardiac valve replacement with CPB,were randomly divided into 4 groups (n =12 each) using a random number table:control group (group C),penehyclidine hydrochloride group (group P),ulinastatin group (group U),and penehyclidine hydrochloride and ulinastatin group (group PU).Penehyclidine hydrochloride 0.02 mg/kg was injected via the right internal jugular vein at 15 min before induction of anesthesia in group P.In group U,the total amount of ulinastatin was 2× 104 U/kg,30％ of the total amount was given via the right internal jugular vein after induction and before surgery,40％ was added to the priming solution,and the remaining 30％ was injected via the right internal jugular vein while the aorta was opened.In group PU,penehyclidine hydrochloride or ulinastatin was given according to the method previously described in group P or U.The equal volume of normal saline was given instead in group C.After induction and before surgery (T1),at 30 min of CPB (T2),and at 30 min and 6 h after termination of CPB (T3,4),blood samples were taken from the left internal jugular bulb and radial artery for blood gas analysis and determination of jugular venous oxygen saturation,jugular venous O2 content,arterial O2 content,and plasma concentrations of S-100β protein and neuron-specific enolase (NSE) (by ELISA).Arteriovenous oxygen content difference (Ca-jrO2) and cerebral O2 extraction rate (CERO2) were calculated.Results Compared with group C,SjvO2 was significantly increased,and CERO2 was decreased at T2.3 in P and U groups and at T2.4 in group PU,and Ca-jvO2 and plasma concentrations of S-100β protein and NSE were decreased at T2,3 in P,U and PU groups.The plasma concentrations of S-100β protein and NSE were significantly lower at T2,3 in group PU than in P and U groups.Conclusion The combination of penehyclidine hydrochloride and ulinastatin produces better efficacy than either alone in attenuating brain injury in patients undergoing cardiac valve replacement with CPB.