Pre-inhalation Sevoflurane During Cardiopulmonary Bypass In Cerebral Oxygen Supply-demand Balance And Post-operative Spirit Of The Impact Of Changes In Nerve Function

Objective: Investigate the effects of per-inhalation anesthesia of sevoflurane during CPB operations on cerebral oxygen supply and demand balance change ,and post- operation nerves function change.Methods:Selective 40 cases patients intracardiac operation underdirect vision operation during CPB,ASAâ…¡^â…¢class, were randomly divided into 4 groups, control group, (C ,n = 10) intravenous infusion of propofol (6～8mg·kg^-1·h^-1) and Sufentanil(1.0～3.0 ug·kg^-1·h^-1); experimental groups (L: n = 10; M: n = 10; H: n = 10): before CPB Pre-absorption sevoflurane difference 0.5MAC, 1.0MAC and 1.5MAC by 40⁶0min.Under general anesthesia during tracheal intubation continuous monitoring the arterial pressure (MAP), electro-cardiogram(ECG), heart rate(HR), central venous pressure (CVP), pulse oxygen saturation(SpO₂), end-tidalCO₂ partial pressure (PETCO₂), urine, nasopharynx(NPT) and rectal temperature. And separately in pre-bypass (T₁), to the nose temperature drop to Constant temperature regularly to 25²8℃(T₂), temperature rose to 32℃(T₃), to a maximum of rewarming (T₄), stopped after bypass 1h(T₅) 5 points for taking his time in patients with radial artery and right jugular bulb for blood gas analysis and blood lactic acid, measure and calculate the jugular bulb oxygen saturation (SjvO₂), arterial oxygen content(CaO₂), actin venous oxygen content difference (AVDO₂), cerebral oxygen uptake rate (CEO₂), artery, jugular bulb blood lactic acid (LA, LV), arterial, jugular bulb bad after 24h, 72h standard neurological examination MMSE score, and the above blood lactate concentration (AVDL), and in the preoperative, intraoperative target, respectively, for statistical treatment, the same group of different time use ANOVA, and in the different group use paired t test.Results:compared with T₁ , the SjvO₂ of every four groups patients were significantly increased; CEO₂, AVDO₂ significantly decreased (P<0.01); the SjvO₂ of H group higher than M group, and H,L groups were significantly higher than C&L groups(P<0.05). The temperature rewarming to NPT 32℃(T3), SjvO₂ of C&L groups decreased significantly than T₁, AVDO₂&CEO₂ significantly increased(P<0.01);and SjvO₂ of M&H Groups were decreased than T2, and M group lower than H group, compare with T₁ there was no significant difference, and significantly higher than the C and L groups(P<0.01), CEO₂ and AVDO₂ were significantly lower than Cand L groups (P<0.05).M contrast with H there was no significant difference. Compared with T₁,T₂,T₃,T₄ the LA,LV were increased progressive (P<0.05),T₃ back down; comparied with T₂, it is more obvious when temperature rewarming (P<0.01). The AVDL in T₂, T₃ compared with T₁ time point there was significant difference (P<0.05). The AVDL of C and L groups at T₃,T₄,T₅ point significantly higher than M and H groups (P<0.05 or 0.01).Conclusion:Adequate pre-inhalation of proper a certain density sevoflurane is beneficial to cerebral oxygen supply balance,The effect depend on the dose ;and result in little effects in after-operation mental nerve functional changes.