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| 心肺转流期间平均动脉压对瓣膜置换术患者脑功能的影响 |
| Effect of mean arterial pressure during cardiopulmonary bypass on brain function of patients undergoing valve replacement |
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| DOI：10.12089/jca.2021.03.002 |
| 中文关键词: 瓣膜置换术 心肺转流 平均动脉压 局部脑氧饱和度 神经特异性烯醇化酶 |
| 英文关键词: Heart valve replacement Cardiopulmonary bypass Mean arterial pressure Regional cerebral oxygen saturation Specific neuron enolase |
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| 中文摘要: |
目的 探讨瓣膜置换术心肺转流（CPB）期间两种不同MAP对局部脑氧饱和度（rScO2）、特异性神经元烯醇酶（NSE）浓度及简易精神状态量表（MMSE)评分的影响。
方法 选择CPB下行瓣膜置换术患者50例，男23例，女27例，年龄35～74岁，BMI 18.5~24.9 kg/m2，ASA Ⅱ或Ⅲ级，NYHA Ⅱ或Ⅲ级。根据CPB期间血压不同分为两组：MAP 70～85 mmHg组（H组）和MAP 55～69 mmHg组（M组），每组25例。记录麻醉诱导前（T0)、CPB期间（T1）、停机后（T2）的rScO2。记录T0、入ICU前（T3）、术后24 h（T4）血浆NSE浓度。记录CPB期间rScO2下降幅度超过20%的发生率。记录术前、术后1 d和术后7 d MMSE评分。
结果 与T0时比较，T1时两组rScO2明显降低，T3时两组NSE浓度明显升高（P<0.05）。与T1时比较，T2时两组rScO2明显升高（P<0.05）。与T3时比较，T4时两组NSE浓度明显降低（P<0.05）。H组CPB期间rScO2下降幅度超过20%的发生率明显高于M组（P<0.05）。与术前比较，术后1 d两组MMSE评分明显降低（P<0.05）。与术后1 d比较，术后7 d两组MMSE评分明显升高（P<0.05）。
结论 在瓣膜置换术CPB期间，不同MAP对术中rScO2、NSE浓度及术后认知功能的影响无明显差异，但MAP 55~69 mmHg时rScO2稳定性更高，可能与去氧肾上腺素使用剂量及间断推注给药的方式有关。 |
| 英文摘要: |
Objective To investigate the effects of two different mean arterial pressures (MAP) on regional cerebral oxygen saturation (rScO2), concentration of specific neuron enolase (NSE) and MMSE scores during cardiopulmonary bypass patients.
Methods Fifty patients undergoing CPB valve replacement surgery, 23 males and 27 females, aged 35-74 years, BMI 18.5-24.9 kg/m2, ASA physical status Ⅱ or Ⅲ, NYHA Ⅱ or Ⅲ, were divided into two groups according to the intraoperative blood pressure level: group M (MAP 55-69 mmHg) and group H (MAP 70-85 mmHg),25 patients in each group. The values of rScO2 and hemodynamic indicators were recorded before induction of anesthesia (T0), during CPB (T1), and after shutdown (T2), and calculate the average; induction of anesthesia plasma NSE was measured before (T0), before entering ICU (T3), and 24 hours after operation (T4). The number of cases where rScO2 during CPB has dropped by more than 20% were recored. Patients were scored with MMSE at 1 day before operation, 1 day after operation and 7 days after operation.
Results Compared with T0, rScO2 in the two groups was significantly reduced at T1(P < 0.05). Compared with T1, rScO2 was significantly increased at T2 in the two groups (P < 0.05). Compared with T0, the NSE concentration of the two groups increased significantly at T3(P < 0.05). Compared with T3, the NSE concentration of the two groups was significantly reduced at T4(P < 0.05). Compared with group M, the number of cases where the rScO2 value decreased by more than 20% during CPB in group H was significantly increased (P < 0.05). Compared with preoperatively, the MMSE scores of the two groups were significantly reduced 1 day after operation (P < 0.05). Compared with 1 day after operation, the MMSE scores of the two groups were significantly increased 7 days after operation (P < 0.05).
Conclusion Different level of MAP have similar effects on intraoperative rScO2, postoperative cognitive function and NSE concentration during CPB of valve replacement. However, rScO2 in group M is more stable in group H, which may be related to the use of norepinephrine. |
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