异氟醚与丙泊酚预处理在小儿体外循环心脏直视手术中脑保护作用的比较研究

目的比较异氟醚和丙泊酚预处理在小儿体外循环心脏直视手术中对脑的保护作用。方法将40例年龄不超过4岁的先天性心脏病患儿随机分为异氟醚组(n=20)和丙泊酚组(n=20),在手术前(T1)、体外循环开始后5min(T2)、阻断主动脉时(T3)、体外循环后30min(T4)、体外循环术毕(T5)、停止体外循环后6h(T6)、停止体外循环后24h(T7)7个时间点采集血样,采用酶联免疫吸附测定(ELISA)法检测血清中S-100β蛋白的表达,头颅CT检测术前、术后患儿的脑部情况。结果两组患儿术前S-100β蛋白的差异无统计学意义(P>0.05),两组S-100β蛋白的表达在体外循环开始后均上升,术后下降至术前水平(P>0.05)。异氟醚组患儿T4和T5时间点的S-100β蛋白表达水平比T1时间点显著升高(P<0.05),丙泊酚组患儿T4、T5和T6时间点的S-100β蛋白表达水平比T1时间点显著升高(P<0.05)。在T4、T5、T6及T7时间点,丙泊酚组患儿S-100β蛋白的表达水平显著高于异氟醚组(P<0.05)。丙泊酚组患儿术后并发症的发生率高于异氟醚组(P<0.05),而两组患儿脑水肿的检出率差异无统计学意义(P>0.05)。结论异氟醚预处理在体外循环小儿心脏直视手术中的脑保护效果方面优于丙泊酚预处理。

A comparative study of protective effects of isoflurance and propofol pretreatment on brain during pediatric open-heart surgery with cardiopulmonary bypass

Objective To compare the protective effects of isoflurance and propofol pretreatment on brain during pediatric open-heart surgery with cardiopulmonary bypass.Methods 40 children with congenital heart disease not more than 4 years old were randomly divided into isoflurance group(n=20)and propofol group(n=20),and their blood samples were collected at seven time points of pre-operation(T1),5 min after cardiopulmonary bypass(T2),aorta blocking-up(T3),30 min after cardiopulmonary bypass(T4),cardiopulmonary bypass end up(T5),6 h after cardiopulmonary bypass end up(T6) and 24 h after cardiopulmonary bypass end up(T7).Enzyme-linked immunosorbent assay(ELISA) was employed to detect the serum S-100β protein expression,and head CT was adopted to scan the brain of children before and after surgery.Results The difference of S-100β protein of children in the two groups before surgery showed no statistical significance(P>0.05).S-100β protein expressions of children in two groups were both increased after cardiopulmonary bypass,and reduced to the preoperative level after surgery(P>0.05).Levels of S-100β protein expression of children in isoflurance group at T4 and T5 time points were markedly higher than that at T1 time point(P<0.05),and those in propofol group at T4,T5 and T6 time points were obviously higher than that at T1 time point(P<0.05).At the time points of T4,T5,T6 and T7,levels of S-100β protein expressions of children in propofol group were significantly higher than those in isoflurance group(P<0.05).Incidence of postoperative complications of children in propofol group was higher than that in isoflurane group(P<0.05),however,the detection rates of cerebral edema of children between the two groups had no statistical difference(P>0.05).Conclusion The protective effect of isoflurance pretreatment on brain during cardiopulmonary bypass in pediatric open-heart surgery is superior to that of propofol pretreatment.