异丙酚和异氟醚对急性颅脑外伤手术患者血清神经元烯醇化酶变化的比较  

Effects of propofol and isoflurane on serum neuron-specific enolase level in surgical patients with acute craniocerebral trauma:a comparative study

作　　者：甘国胜[1] 王焱林[1] 陈利民[2] 沈七襄[2] 余剑波[2] 丘伟[3] 

机构地区：[1]武汉大学中南医院麻醉学教研室,湖北武汉430071 [2]广州军区武汉总医院麻醉科,湖北武汉430070 [3]广州军区武汉总医院中心实验室,湖北武汉430070

出　　处：《第一军医大学学报》2005年第7期858-860,共3页Journal of First Military Medical University

摘　　要：目的研究急性颅脑外伤手术前和手术期间的血清神经元烯醇化酶(NSE)的变化及异丙酚和异氟醚对这一变化的影响。方法10例泌尿系统手术的非颅脑损伤患者为正常对照组,以酶联免疫吸附方法测定术前血清NSE含量。急症颅脑外伤手术患者30例,随机分为异丙酚组(A组)和异氟醚组(B组),每组15例。两组患者分别于手术前、手术2h、手术结束时测定血清NSE含量。对急症颅脑外伤手术患者进行格拉斯哥评分并记录。结果脑外伤病人手术前NSE显著高于正常对照组(P<0.01),哥拉斯哥评分越低的病人术前NSE越高(r=-0.494,P<0.01);手术结束时异丙酚组NSE显著低于异氟醚组(P<0.05);开颅手术2h和手术结束时两组NSE均较术前升高。结论急性颅脑外伤时患者血清NSE浓度是升高的,颅脑损伤越重,血清NSE浓度越高。开颅手术期间持续静脉泵注临床麻醉剂量的异丙酚可减轻继发性脑损害,降低血清NSE浓度的升高,具有脑保护作用,是颅脑手术麻醉的理想药物。Objective To investigate changes in serum neuron-specific enolase (NSE) concentration in patients before,during and after surgery for acute craniocerebral trauma,and examine the effects of propofol and isoflurane on these changes.Methods Ten patients scheduled for urinary operation without cerebral injury were enrolled in the control group.Thirty patients with acute cerebral trauma were randomly allocated to propofol group (n=15) and isoflurane group (n=15).Serum concentrations of NSE before surgery,2 h after the surgery began,and after completion of surgery were measured in all the patients by enzyme-linked immunoadsorbent assay.Glasgow scores of patients with cerebral trauma were also estimated and recorded.Results Serum concentration of NSE in patients with cerebral trauma were significantly higher than those in the control group before the surgery (P<0.01).The Glasgow score was inversely correlated with serum NSE concentration (r=-0.494,P<0.01).Serum NSE level after completion of surgery was significantly lower in propofol group than in isoflurane group (P<0.05).NSE levels at 2 h after the initiation of the surgery and after the completion of surgery were higher than those before the surgery.Conclusions Serum NSE concentration increases in patients with acute cerebral injury in parallel to the severity of brain damage.Application of propofol by intravenous pumping can reduce the increase in serum NSE,alleviate cerebral injury,and protect the brain tissues of patients undergoing surgery for acute craniocerebral trauma.

关 键 词：异丙酚 异氟醚 颅脑外伤 神经元烯醇化酶 

分 类 号：R614[医药卫生—麻醉学]