体外循环中不同双频指数下丙泊酚或依托咪酯对脑氧代谢的影响.DOCVIP

临床医学论文-体外循环中不同双频指数下丙泊酚或依托咪酯对脑氧代谢的影响 【摘要】? 　　目的 讨论在浅低温体外循环(extracorporeal circulation,ECC)术中，脑电双频指数（BIS）抑制程度不同时丙泊酚或依托咪酯对脑氧代谢的影响。方法 18例ECC下行冠状动脉旁路移植术患者，随机分丙泊酚组和依托咪酯组。术中给予大剂量丙泊酚或依托咪酯，使BIS降低至0。分别在给药前、后及BIS下降到不同程度时，抽取颈内静脉球部血液和桡动脉血液计算脑氧摄取率（COE）。结果 两组在各个时间点的COE均无差异。结论 在浅低温ECC中丙泊酚或依托咪酯对BIS的抑制程度与剂量呈正相关；在浅低温ECC中使BIS下降到0时的大剂量丙泊酚或依托咪酯对COE无影响。 【关键词】? 丙泊酚　依托咪酯　双频指数　脑氧摄取率 ??? Abstract: OBJECTIVE?? To evaluate and compare the effects of high doses propofol or etomidate? on cerebral oxygen extraction (COE) during light hypothermic extracorporeal circulation（ECC） in selective coronary artery bypass graft（CABG） patients. METHODS? Patients (n=18) were randomly entered into one of the two groups: propofol or Eetomidate group. All the study drugs were given through the subclavicular vein after aotic artery clamping until the bispectral indx（BIS）decreasing to zero. The blood gas samples were drawn from the radial artery and jugular venous bulb before the drugs were given (baseline point), and when BIS was inhibited to 75%, 50%, 25% and 0% (BIS=0) of baseline point . The COE was calculated and hemodynamic data were recorded.?RESULTS?There was no difference of COE among the groups at every time point. CONCLUSION?The changes of BIS caused by 1%propofol or 0.2% etomidte was negatively correlative with their doses during light hypothemic ECC. All the study drugs can reduce BIS to zero. The high doses of propofol or etomidate of BIS zero can not change COE. ??? Key words：? Propofol; Etomidate; BIS; COE ??? 本实验设计在冠状动脉搭桥（CABG）手术浅低温体外循环(extracorporeal circulation,ECC)时，给予大剂量丙泊酚和依托咪酯，至脑电双频指数（BIS）为0。观察在BIS不同抑制程度时，丙泊酚和依托咪酯对脑氧代谢的影响。 ??? 1? 资料与方法 ??? 1.1? 一般资料? 经本院伦理委员会批准，选择ECC下行CABG患者18名。随机分为2组，丙泊酚组（P组，n=9），依托咪酯组（E组，n=9）。排除高血压、糖尿病药物控制不平稳、既往有脑血管疾病史和急诊CABG者。 ??? 1.2? 麻醉方法? 术前酌情给予适当血管活性药物及安定10 mg口服，吗啡和东莨宕碱肌肉注射。咪唑安定、依托咪酯、阿端和芬太尼诱导。阿端0.75mg/(kg·h)和芬太尼20～40μg/kg维持，间断吸入1％安氟烷加深麻醉。SpaceLabs多功能监测仪监测脉搏血氧饱和度，动、静脉压力，ECG，呼吸末二氧化碳（PetCO2），肛肠和鼻咽温度。右侧颈内静脉逆行穿刺放置16G单腔静脉导管。Aspect A-1000脑电监测仪双通路前额导联监测BIS。 ??? 1.3? ECC方