Effects of sevoflurane before cardiopulmonary bypass on cerebral oxygen balance and early postoperative cognitive dysfunction
Effects of sevoflurane before cardiopulmonary bypass on cerebral oxygen balance and early postoperative cognitive dysfunction
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DOI：
10.1007/s10072-013-1347-3
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发表时间：
2013-12-01
影响因子：
3.3
通讯作者：
Zhang, Yi-Nan
中科院分区：
文献类型：
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作者：
Xu, Ji-Hong;Zhang, Tie-Zheng;Zhang, Yi-Nan
术后认知功能障碍（POCD）与体外循环（CPB）有关。我们研究了CPB前吸入不同剂量七氟烷对脑氧供需的影响，以及相关的早期POCD的发生率。将120例患者随机分配至4个治疗组（每组n = 30），并在CPB前给予高[1.5最小肺泡浓度（MAC）]、中等（1.0 MAC）、低（0.5 MAC）或无七氟烷剂量。在不同时间点测定标准血气参数、血清S-100蛋白和神经元特异性烯醇化酶（NSE）。分别于术前1 d、术后24 h和72 h进行简易精神状态检查（MMSE）。在鼻咽温度为25-28 A ℃时，中剂量和高剂量组的颈静脉球静脉血氧饱和度（SjvO（2））显著高于对照组，而动静脉氧含量差（AVDO（2））和脑氧摄取量（CEO 2）显著降低。中、高剂量组停CPB后1、6 h血清S-100蛋白和NSE浓度均显著低于对照组。中、高剂量组术后24 h MMSE评分显著高于低剂量组和对照组。吸入最佳浓度的七氟烷可能有利于CPB期间的脑氧平衡，并可能改善认知损害。然而，该效应具有剂量依赖性。
Postoperative cognitive dysfunction (POCD) is associated with cardiopulmonary bypass (CPB). We investigated the effect of different doses of inhaled sevoflurane administered prior to CPB on cerebral oxygen supply and demand, and the incidence of associated early POCD. One hundred and twenty patients were randomly allocated into four treatment groups (n = 30, each) and administered a high- [1.5 minimum alveolar concentration (MAC)], moderate- (1.0 MAC), low- (0.5 MAC), or no- sevoflurane dose prior to CPB. Standard blood gas parameters, serum S-100 protein, and neuron-specific enolase (NSE) were measured at different time points. The mini-mental state examination (MMSE) was administered 1 day before and 24 and 72 h after surgery. The jugular bulb venous oxygen saturation (SjvO(2)) in the moderate- and high-dose groups at a nasopharyngeal temperature of 25-28 A degrees C was significantly higher compared with the control group, while the arteriovenous oxygen content difference (AVDO(2)) and cerebral extraction of oxygen (CEO2) were significantly reduced. The serum S-100 protein and NSE concentrations of the moderate- and high-dose groups at 1 and 6 h after the cessation of CPB were significantly lower than that of the control group. The 24 h postoperative MMSE scores of the moderate- and high-dose groups were significantly higher than those of the low-dose and control groups. An inhaled optimal concentration of sevoflurane may be beneficial for cerebral oxygen balance during CPB, and may ameliorate cognitive damage. However, the effect is dose-dependent.