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Objective To investigate the relationship between inflammatory response and depth of propofol sedation during cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Fifty patients undergoing cardiac valve replacement with CPB were randomly divided into low Bispectral index (BIS)group(30≤BIS<45)and high BIS group(45≤BIS≤60).Each group had 25 cases.The induction of anesthesia in the two groups was in the same way.Anesthesia was maintained in the fol‐lowing way :low BIS group and high BIS group received intravenous infusion of 7 mg/(kg · h) and 3 mg/(kg · h) propofol ,re‐spectively.In operation ,the propofol infusion rate was adjusted to maintain each group in the corresponding BIS value range.Before induction of anesthesia(T0 ) ,at the end of the CPB(T1 ) ,the end of operation(T2 )and 1 h after operation(T3 ) ,re‐spectively ,6 mL of jugular vein blood samples were collected.The concentrations of IL‐6 ,TNF‐αand S100βprotein in the serum were detected by ELISA method.At T0 ,T1 and T2 ,respectively ,arterial blood was collected ,the pH of blood and the concentra‐tions of blood glucose and lactate were determined.Results At T1 ,T2 and T3 ,the concentrations of IL‐6 and TNF‐αin serum in low BIS group were all lower than those in the high BIS group(all P<0.05).At T2 and T3 ,the S100βprotein concentrations in serum in the low BIS group were all lower than those in the high BIS group (both P< 0.05).Compared with the high BIS group ,the concentrations of blood glucose and lactate in low group at T 1 and T2 were all lower(all P<0.05).Conclusion Ap‐propriately enhancing the depth of sedation could help relieve the inflammatory reaction of patients during cardiac valve replace‐ment with CPB.It can help protect brain tissue and reduce the incidence of brain injury.
RESUMO
Objective To investigate the reliability of Narcotrend for monitoring the depth of sedation [the observer's assessment of alterness/sedation(OAA/S) scale] with midazolam and correlation between the depth of sedation and Narcotrend index.Methods 0 ASA Ⅰ-Ⅱ status patients scheduled for elective lower limb operations underwent spinal anesthesia,who were given target-controlled infusion of midazolam.Target plasma concentration was 50ng/ ml at first and increased by 10 ng/ml each grade until OAA/S scale became 1 point.Each target concentration infusion was maintained for 5min.Observe the patient the OAA/S scale to be 5 points.If the operation was not over yet,regulated the appropriate depth of sedation until the end of operation.The Narcotrend index of different OAA/S scale and heart rate,mean arterial pressure,respiration were recorded.Results In the deepening or recovery phase of sedation,OAA/S scales were correlated with Narcotrend index (Spearman' s r =0.786,0.652,all P ＜ 0.05).Conclusion Narcotrend is a good index to guide target controlled infusion of midazolam,the index is closely related with the depth of sedation of midazolam.