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目的观察婴幼儿体外循环(cardiopulmonary bypass,CPB)心脏直视手术中异氟烷预处理对脑的保护作用。方法 42例年龄≤3岁的先天性心脏病患儿分为异氟烷预处理组和对照组两组(n=21),行快速麻醉诱导插管后,异氟烷预处理组持续吸入1～1.5 MAC异氟烷,对照组不行异氟烷预处理。两组在术前(T1)、CPB开始5 min(T2)、阻断主动脉(T3)、CPB后30 min(T4)、CPB结束时(T5)、CPB结束后6 h(T6)、24 h(T7)分别采取血样,ELISA法检测血清中S100β蛋白和神经特异性烯醇化酶(NSE)表达变化情况。结果两组术前S100β和NSE无统计学差异(P>0.05);异氟烷预处理组S100β蛋白和NSE从CPB开始到结束后24 h内各时间点与术前相比无显著差异(P>0.05);对照组术前S100蛋白及NSE水平与T4、T5及T6时间点相比有明显差异(P<0.05),与T7时间点相比统计学意义不显著(P>0.05)。S100β蛋白在T5时间点达到最大值,NSE在T6时间点达到最大值。对照组在术后T4～T6时间点与异氟烷预处理组相比显著上升(P<0.05)。对照组(r=0.684)和异氟烷预处理组(r=0.648)S100β蛋白和NSE浓度的变化均呈明显的正相关性(P<0.05)。结论异氟烷预处理后能够显著降低婴幼儿CPB心脏直视手术中S100β和NSE的含量。
Objective To observe the protective effects of isoflurane preconditioning on brain in infants with cardiopulmonary bypass (CPB). Methods Forty-two children with congenital heart disease aged ≤3 years were divided into two groups (n = 21): Isoflurane pretreatment group and control group. After intubation was induced by rapid anesthesia, ~ 1.5 MAC isoflurane, the control group is not preconditioned with isoflurane. Two groups were divided into three groups: preoperative (T1), CPB 5 min (T2), aortic cross-clamping (T3), 30 min after CPB (T4), CPB ending (T5), 6 h h (T7) were taken blood samples were detected by ELISA serum S100β protein and neuron-specific enolase (NSE) expression changes. Results There was no significant difference in preoperative S100β and NSE between the two groups (P> 0.05). There was no significant difference in the expression of S100β protein and NSE between pre-CPB and intra-24 hours after CPB > 0.05). The level of preoperative S100 protein and NSE in control group was significantly lower than that in T4, T5 and T6 time points (P <0.05), but not significantly different from that in T7 (P> 0.05). S100βprotein reached the maximum at T5 time point and NSE reached the maximum at T6 time point. The control group at T4 ~ T6 time point after isoflurane preconditioning group was significantly increased (P <0.05). There was a significant positive correlation between S100β protein and NSE concentration in control group (r = 0.684) and isoflurane preconditioning group (r = 0.648) (P <0.05). Conclusion Isoflurane preconditioning can significantly reduce the content of S100β and NSE in infants undergoing open heart surgery CPB.