Wiedemann K, Jürs G, Krier C, Assmus A
Anasth Intensivther Notfallmed. 1987 Apr;22(2):73-7.
Thiopentone (thp) infusion was administered to 33 patients with cerebral dysfunction or convulsions out of 2986 patients operated on via extracorporeal circulation because of valvular disease, coronary insufficiency, septum defects and intrathoracic aortic aneurysms. If phenytoin, diazepam and clonazepam proved ineffective, thp 10-15 mg/kg was injected slowly, followed by infusion of 2-4 mg/kg/h for 0.5-5 days. 9 patients died. 18 survivors had a good recovery, 6 were moderately disabled. In the survivors embolisation of particulate matter prevailed as a cause of cerebral dysfunction while in nonsurvivors prolonged pre- and postoperative hypotension was the main cause, with one patient suffering a hemispheric infarction. The amelioration of convulsions and psychosyndromes in the survivors is compatible with the known anticonvulsive effect of thp and its alleged influence on cerebral focal ischaemia. However, in protracted cerebral hypoperfusion as a cause of cerebral dysfunction no protection can be expected from thp. The known effects of barbiturates do not justify the use of these substances for the purpose of cerebral protection.
在2986例因瓣膜病、冠状动脉供血不足、室间隔缺损和胸主动脉瘤而接受体外循环手术的患者中，对33例出现脑功能障碍或惊厥的患者给予硫喷妥钠（thp）输注。若苯妥英钠、地西泮和氯硝西泮无效，则缓慢注射10 - 15mg/kg的thp，随后以2 - 4mg/kg/h的速度输注0.5 - 5天。9例患者死亡。18例幸存者恢复良好，6例有中度残疾。在幸存者中，颗粒物质栓塞是脑功能障碍的主要原因，而在非幸存者中，术前和术后长时间低血压是主要原因，有1例患者发生半球梗死。幸存者惊厥和精神综合征的改善与thp已知的抗惊厥作用及其对脑局灶性缺血的所谓影响相符。然而，对于因长期脑灌注不足导致的脑功能障碍，thp无法提供保护。巴比妥类药物的已知作用并不足以证明使用这些物质进行脑保护的合理性。
