【摘要】 目的 探讨七氟烷吸入对体外循环（CPB）心脏瓣膜置换术患者脑损伤和术后认知功能的影响。方法 选取2020年1月至2022年12月在南阳市中心医院诊治的150例CPB心脏瓣膜置换术患者，随机分为对照组和研究组，各75例。对照组接受全麻，研究组在对照组的基础上于动脉开放前2 min从体外肺转流机的人工肺吹入七氟烷，持续20 min。比较两组围手术期相关指标，比较麻醉诱导前（T₀）、CPB开始20 min（T₁）、CPB停机即刻（T₂）、CPB停机后6 h（T₃）、CPB停机后24 h（T₄）的S100β蛋白（S100β）、神经元特异性烯醇化酶（NSE）,比较术前、术后1 d、术后3 d的简易精神状态检查（MMSE）、蒙特利尔认知功能量表（MoCA）评分，比较两组心肌缺血事件、心脏复跳情况及心律失常发生情况。结果 两组手术时间、CPB时间比较差异无统计学意义（P>0.05）,研究组苏醒时间、拔管时间、ICU停留时间、住院时间短于对照组（P<0.05）。在T₁、T₂、T₃、T₄时点两组S100β、NSE较T₀时点升高（P<0.05）,但研究组低于对照组（P<0.05）。术后1、3 d两组MMSE、MoCA评分较术前均降低，但研究组高于对照组（P<0.05）。两组心肌缺血事件率/心律失常率、自动复跳率、复跳时用药率、复跳时除颤率、复跳后心脏节律比较，差异无统计学意义（P>0.05）。结论 七氟烷吸入应用于CPB心脏瓣膜置换术患者，可有效减轻脑损伤，减轻对术后认知功能的损伤，促进患者快速康复。更多还原

【Abstract】 Objective To investigate the effects of sevoflurane inhalation on brain injury and postoperative cognitive function in patients undergoing heart valve replacement under cardiopulmonary bypass（CPB）.Methods A total of 150 patients with CPB heart valve replacement diagnosed and treated in Nanyang Central Hospital from January 2020 to December 2022 were randomly divided into control group and research group, with 75 cases in each group. The control group accepted general anesthesia, and the research group accepted sevoflurane from the artificial lung of extracorporeal pulmonary bypass machine at 2 minutes before arterial opening for 20 minutes on the basis of the control group. Compared perioperative related indicators of two groups. S100β protein（S100 β） and neuron-specific enolase（NSE） before anesthesia induction（T₀）, 20 minutes after CPB start（T₁）, immediately after CPB stop（T₂）, 6 hours after CPB stop（T₃） and 24 hours after CPB stop（T₄） were compared. Mini-mental state examination（MMSE） and Montreal cognitive assessment（MoCA） scores before, 1 day after and 3 days after surgery were compared. Myocardial ischemic events, cardiac rebound and arrhythmia occurrence of two groups were compared.Results There was no statistical difference in operation time and CPB time between the two groups（P>0.05）. The recovery time, extubation time, ICU stay time and hospitalization time in research group were shorter than those in control group（P<0.05）. At T₁, T₂, T₃ and T₄, S100β and NSE in both groups were higher than those in T₀（P<0.05）, but research group was lower than control group（P<0.05）. The scores of MMSE and MoCA in the two groups were lower than those before operation, but the scores in research group were higher than those in control group（P<0.05）. There was no statistical difference in myocardial ischemic event rate/arrhythmia rate, automatic rebound rate, drug use rate during rebound, defibrillation rate during rebound and cardiac rhythm after rebound between the two groups（P>0.05）.Conclusion Sevoflurane inhalation in patients undergoing CPB heart valve replacement can effectively alleviate brain injury, reduce postoperative cognitive impairment and promote patients’ rapid recovery.更多还原