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目的探讨异丙酚和尼莫地平预处理在婴幼儿体外循环心脏手术中脑保护作用。方法 90例先天性心脏病行体外循环心脏手术婴幼儿,分为异丙酚组30例、尼莫地平组30例和手术对照组30例,30例体检健康婴幼儿为健康对照组。异丙酚组患儿麻醉诱导时给予质量分数1%异丙酚6mg/(kg·h)持续泵入至手术结束;尼莫地平组患儿麻醉诱导前给予质量分数0.2%尼莫地平7.5μg/(kg·h)持续泵注至气管导管拔出;手术对照组患儿麻醉诱导前给予等容生理盐水持续泵注至气管导管拔出。异丙酚组、尼莫地平组、手术对照组于手术前(T_0)、体外循环开始30min(T_1)、停体外循环即刻(T_2)、停体外循环6h(T_3)、停体外循环12h(T_4)、停体外循环24h(T_5)、停体外循环48h(T_6)采血,健康对照组于体检时采血,各组检测不同时间点血红蛋白和红细胞压积,采用ELISA法检测各时间点血清星形胶质细胞S-100β蛋白(astroglial cell S-100βprotein,S-100β)、神经原特异性烯醇化酶(neuron-specific enolase,NSE)水平,并进行比较。结果异丙酚组、尼莫地平组和手术对照组患儿T_1时血红蛋白[(7.65±0.87)、(7.72±0.82)、(7.14±0.78)g/L]和红细胞压积[(20.02±1.93)%、(19.89±1.87)%、(18.32±1.69)%]明显低于健康对照组[(12.41±2.01)g/L、(32.82±2.63)%]和各组T_0时(P<0.05);异丙酚组和尼莫地平组患儿T_2时血清S-100β[(0.62±0.11)、(0.59±0.12)μg/L)和NSE蛋白[(5.79±1.14)、(5.82±1.23)μg/L]水平明显高于健康对照组[(0.43±0.07)、(4.58±0.32)μg/L]和各组T_0时(P<0.05),手术对照组T_1~T_4时血清S-100β和NSE蛋白水平明显高于异丙酚组和尼莫地平组T_0~T_4时及本组T_0时(P<0.05);异丙酚组各时间点各指标与尼莫地平组比较差异均无统计学意义(P>0.05)。结论异丙酚和尼莫地平在婴幼儿体外循环心脏手术中均具有脑保护,二者脑保护效果相当。
Objective To investigate the protective effects of propofol and nimodipine on cardiopulmonary bypass during cardiopulmonary bypass in infants and young children. Methods Totally 90 infants with congenital heart disease undergoing cardiac surgery under cardiopulmonary bypass were divided into 30 cases of propofol group, 30 cases of nimodipine group and 30 cases of operation control group, and 30 cases of healthy infants as healthy control group. Propofol 6mg / (kg · h) was continuously pumped into the propofol group at the end of anesthesia induction. The nimodipine group was given 7.5μg / (kg · h) continued to pump into the endotracheal tube pull out; surgical control group children given equal volume of saline before anesthesia induction pump until the endotracheal tube pull out. The propofol group, nimodipine group and operation control group were treated with T_0, T_1, T_2, T_3, T_4 (T_5), and stop the extracorporeal circulation for 48h (T_6). Blood was collected from the healthy control group at the time of physical examination. Hemoglobin and hematocrit were measured at different time points in each group. The levels of serum astrocytes S-100βprotein (S-100β) and neuron-specific enolase (NSE) were detected and compared. Results The levels of hemoglobin at T 1 were significantly higher in propofol group, nimodipine group and operation control group [(7.65 ± 0.87), (7.72 ± 0.82), (7.14 ± 0.78) g / L] and (20.02 ± 1.93 ), (19.89 ± 1.87)% and (18.32 ± 1.69)%, respectively, were significantly lower than those in the healthy control group (12.41 ± 2.01 g / L, 32.82 ± 2.63%, P <0.05) ; The levels of serum S-100β (0.62 ± 0.11), (0.59 ± 0.12) μg / L) and NSE protein [(5.79 ± 1.14), (5.82 ± 1.23) μg / L] was significantly higher than that in the healthy control group [(0.43 ± 0.07), (4.58 ± 0.32) μg / L] and T 0 in each group (P <0.05) The protein level was significantly higher than that of propofol group and nimodipine group at T 0 ~ T 4 and at T 0 (P <0.05). There was no significant difference between propofol group and nimodipine group at each time point (P> 0.05). Conclusion Both propofol and nimodipine have neuroprotective effects during cardiopulmonary bypass in infants and young children.