心肺转流期间平均动脉压对瓣膜置换术患者脑功能的影响

目的 探讨瓣膜置换术心肺转流(CPB)期间两种不同MAP对局部脑氧饱和度(rScO2)、特异性神经元烯醇酶(NSE)浓度及简易精神状态量表(MMSE)评分的影响.方法 选择CPB下行瓣膜置换术患者50例,男23例,女27例,年龄35～74岁,BMI 18.5～24.9 kg/m2,ASAⅡ或Ⅲ级,NYHAⅡ或Ⅲ级.根据...

Effect of mean arterial pressure during cardiopulmonary bypass on brain function of patients undergoing valve replacement

Objective To investigate the effects of two different mean arterial pressures(MAP)on regional cerebral oxygen saturation(rScO₂),concentration of specific neuron enolase(NSE)and MMSE scores during cardiopulmonary bypass patients.Methods Fifty patients undergoing CPB valve replacement surgery,23 males and 27 females,aged 35-74 years,BMI 18.5-24.9 kg/m 2,ASA physical statusⅡorⅢ,NYHAⅡorⅢ,were divided into two groups according to the intraoperative blood pressure level:group M(MAP 55-69 mmHg)and group H(MAP 70-85 mmHg),25 patients in each group.The values of rScO₂ and hemodynamic indicators were recorded before induction of anesthesia(T₀),during CPB(T₁),and after shutdown(T₂),and calculate the average;induction of anesthesia plasma NSE was measured before(T₀),before entering ICU(T₃),and 24 hours after operation(T₄).The number of cases where rScO₂ during CPB has dropped by more than 20%were recored.Patients were scored with MMSE at 1 day before operation,1 day after operation and 7 days after operation.Results Compared with T₀,rScO₂ in the two groups was significantly reduced at T₁(P<0.05).Compared with T₁,rScO₂ was significantly increased at T₂ in the two groups(P<0.05).Compared with T₀,the NSE concentration of the two groups increased significantly at T₃(P<0.05).Compared with T₃,the NSE concentration of the two groups was significantly reduced at T₄(P<0.05).Compared with group M,the number of cases where the rScO₂ value decreased by more than 20%during CPB in group H was significantly increased(P<0.05).Compared with preoperatively,the MMSE scores of the two groups were significantly reduced 1 day after operation(P<0.05).Compared with 1 day after operation,the MMSE scores of the two groups were significantly increased 7 days after operation(P<0.05).Conclusion Different level of MAP have similar effects on intraoperative rScO₂,postoperative cognitive function and NSE concentration during CPB of valve replacement.However,rScO₂ in group M is more stable in group H,which may be related to the use of norepinephrine.