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采用三种不同麻醉技术行冠状动脉旁路移植术患者的S100β水平比较及其与血流动力学指标的相关性

Comparison of S100β levels, and their correlation with hemodynamic indices in patients undergoing coronary artery bypass grafting with three different anesthetic techniques.

作者信息

Singh Sarvesh Pal, Kapoor Poonam Malhotra, Chowdhury Ujjwal, Kiran Usha

机构信息

Department of Cardiac Anaesthesia, CN Centre, All India Institute of Medical Sciences, New Delhi, India.

出版信息

Ann Card Anaesth. 2011 Sep-Dec;14(3):197-202. doi: 10.4103/0971-9784.83998.

Abstract

Cardiac surgery with aid of cardiopulmonary bypass (CPB) is associated with neurological dysfunction. The presence of cerebrospecific protein S100β in serum is an indicator of cerebral damage. This study was designed to evaluate the influence of three different anesthesia techniques, on S100β levels, in patients undergoing coronary artery bypass grafting on CPB. A total of 180 patients were divided into three groups - each of who received sevoflurane, isoflurane and total intravenous anesthesia as part of the anesthetic technique, respectively. S100 were evaluated from venous sample at following time intervals - prior to induction of anesthesia (T1), after coming off CPB (T2); 12 h after aortic cross clamping (T3) and 24 h after aortic cross clamping (T4). In all three groups, maximal rise in S100β levels occurred after CPB which gradually declined over next 24 h, the levels at 24 h post-AOXC being significantly higher than baseline levels. Significantly low levels of S100β were noted at all postdose hours in the sevoflurane group, as compared to the total intravenous anesthesia (TIVA) group, and at 12 and 24 h postaortic cross clamp, in comparison to the isoflurane group. Comparing the isoflurane group with the TIVA group, the S100 levels were lower in the isoflurane group only at 24 h postaortic cross clamp. It was concluded that maximum rise in S100β levels occurs immediately after CPB with a gradual decline in next 24 h. The rise in S100β levels is significantly less in patients administered sevoflurane in comparison to isoflurane or TIVA. Hemodynamic parameters had no influence on the S100β levels during the first 24 h after surgery.

摘要

在体外循环(CPB)辅助下进行心脏手术与神经功能障碍相关。血清中脑特异性蛋白S100β的存在是脑损伤的一个指标。本研究旨在评估三种不同麻醉技术对接受CPB冠状动脉搭桥术患者S100β水平的影响。总共180例患者被分为三组,每组分别接受七氟醚、异氟醚和全静脉麻醉作为麻醉技术的一部分。在以下时间间隔从静脉样本中评估S100:麻醉诱导前(T1)、CPB结束后(T2);主动脉阻断钳夹后12小时(T3)和主动脉阻断钳夹后24小时(T4)。在所有三组中,CPB后S100β水平出现最大升高,随后在接下来的24小时内逐渐下降,主动脉阻断钳夹后24小时的水平显著高于基线水平。与全静脉麻醉(TIVA)组相比,七氟醚组在所有给药后时间点的S100β水平均显著较低,与异氟醚组相比,在主动脉阻断钳夹后12小时和24小时也是如此。将异氟醚组与TIVA组进行比较,异氟醚组仅在主动脉阻断钳夹后24小时的S100水平较低。得出的结论是,CPB后立即出现S100β水平的最大升高,随后在接下来的24小时内逐渐下降。与异氟醚或TIVA相比,接受七氟醚治疗的患者S100β水平的升高显著较少。术后24小时内血流动力学参数对S100β水平没有影响。

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