异丙酚对急性颅脑外伤手术脑保护作用的临床研究  

Clinical studies on the protective effect of propofol in surgery of acute cranial trauma

作　　者：甘国胜[1] 宋晓阳[1] 余剑波[1] 陈利民[1] 邬明[2] 丘伟[3] 

机构地区：[1]广州军区武汉总医院麻醉科,武汉430070 [2]广州军区武汉总医院急诊科,武汉430070 [3]广州军区武汉总医院中心实验室,武汉430070

出　　处：《解放军医学杂志》2005年第10期923-925,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的研究急性颅脑外伤患者手术前和手术期间血清神经元特异性烯醇化酶(NSE)和S100蛋白(S100B)的变化及静脉麻醉剂异丙酚对这一变化的影响,评价异丙酚的脑保护作用。方法10例无颅脑损伤的泌尿系统手术患者为正常对照组。急症颅脑外伤手术患者30例,随机分为异丙酚组(A组,n=15)和异氟醚组(B组,n=15)。两组患者分别于手术前,手术开始2h,手术结束时测定血清NSE和S100B含量。正常对照组只在术前测定血清NSE和S100B含量。对急症颅脑外伤手术患者进行格拉斯哥评分并记录。结果急性脑外伤患者手术前NSE和S100B显著高于正常对照组(P<0·01),格拉斯哥评分越低的口才1术前NSE和S100B也越高。手术结束时异丙酚组NSE和S100B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和S100B均较术前升高。结论急性颅脑外伤手术患者血清NSE和S100B含量升高,开颅手术期间持续静脉泵注临床麻醉剂量的异丙酚可降低血清NSE和S100B水平,减轻继发性脑损害,具有脑保护作用,是颅脑手术麻醉的理想药物。Objective To investigate the changes in neuron-specific enolase （NSE） and S100B in patient＇s serum before, during and after surgery of acute cerebral trauma, and to examine the influence of propofol, a venous anesthetic, on these changes, so as to evaluate the brain-protective effects of this agent. Methods Ten patients with no cerebral injury and scheduled for urological operation served as control group. Thirty patients with cerebral trauma were randomly allocated to either propofol group （n= 15） or isoflurane group （n= 15）. NSE and S100B were measured by ELISA in both propofol and isoflurane groups before surgery, 2 hours after cranial surgery started, and after surgery. The same measurement was done in the control group only before surgery. Glasgow scores of patients with cerebral trauma were estimated and recorded. Results Before surgery, the NSE and S100B in the patients with cerebral trauma were significantly higher than that in the control group （P〈0.01）. The Glasgow score was negatively correlated with the concentrations of NSE and S100B. Serum concentrations of NSE and S100B after the surgery were significantly lower in the propofol group compared with that in the isoflurane group （P〈0.05）. Serum concentrations of NSF and S100B were elevated 2h after the initiation of the surgery and after the surgery compared with that before the surgery. Conclusions Serum concentrations of NSE and S100B increased in the patients of acute cerebral trauma, and the more serious the trauma was, the more increase in the contents of NSE and S100B. The application of anesthetic propofol by intravenous pumping might suppress the increase of NSE and S100B in sera, attenuate the secondary cerebral injury, and exert a protective influence on the brain. Therefore, propofol could be considered as an ideal anesthetic in cerebral surgery.

关 键 词：异丙酚 颅脑损伤 神经元特异性烯醇化酶 S100蛋白质类 

分 类 号：R971.2[医药卫生—药品] R651.15[医药卫生—药学]