不同麻醉药预处理对颅脑手术患者的脑保护作用  

Effect of different anesthetics pretreatment on brain neuroprotection in patients undergoing neurosurgery

作　　者：宋爽[1] 刘秀娟[1] 

机构地区：[1]山东省东营市胜利石油管理局胜利医院麻醉科,257055

出　　处：《中华临床医师杂志（电子版）》2014年第12期50-53,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的：研究不同药物的麻醉预处理对颅脑手术患者脑功能变化的影响。方法选择颅脑神经顺应性正常行颅脑手术的患者75例。随机分为五组，每组15例：A组，对照组；B组，异丙酚预处理组；C组，异氟醚预处理组；D组，利多卡因预处理组；E组，异丙酚＋利多卡因预处理组。气管插管后至开颅钻孔时，B、C、D、E组实施不同的麻醉预处理。监测并检验患者诱导前（T0）、手术结束时（T1）静脉血乳酸（LAD）、丙二醛（MDA）、超氧化物歧化酶（SOD）、神经元特异性烯醇化酶（NSE）含量；T0时和术后24 h（T2）、48 h（T3）、3 d（T4）时IL-1、TNF-α、乳酸脱氢酶（LDH）、肌磷酸激酶（CPK）含量。结果与T0时比较，各组T1时NSE含量均较高（P＜0.05）；SOD、MDA值均有不同程度的升高，其中E组SOD值和A组MDA升高具有统计学差异（P＜0.05）；LAD无统计学差异。与T0时比较，T2～T4时各组IL-1、TNF-α、LDH、CPK值均有不同程度的升高（P＜0.05）；与A组比较， E组T2～T4时IL-1、TNF-α、LDH、CPK均有统计学差异（P＜0.05）；与E组比较，B、C、D组T4时IL-1、TNF-α、LDH、CPK值升高幅度具有统计学差异（P＜0.05）。结论应用异丙酚、异氟醚、利多卡因行麻醉预处理，对颅脑手术患者均有一定的脑保护作用。在抑制炎性反应及预防缺血再灌注损伤方面，异丙酚＋利多卡因联合麻醉预处理，脑保护效应更为显著。ObjectiveTo evaluate effect of anesthetic pretreatment with different drugs on brain function changes in patients undergoing neurosurgery.Methods Seventy-five （40 males and 35 females） ASAⅠorⅡ neurosurgical patients, whose cranial nerve compliance was normal, aged 18-61 yr undergoing elective surgery under general anesthesia were randomly divided into 5 groups （n=15 each）： group A （control group）;group B, pretreated with TCL of propofol（Cp 5μg/ml）;group C, pretreated with inhaled isoflurane （MAC value of 2.0）;group D, pretreated with TCL of lidocaine（Cp 5μg/ml）;group E, pretreated with TCL of propofol （Cp 5μg/ml） and lidocaine（Cp 5μg/ml）. Anesthesia was induced with etomidate （0.2 mg/kg）, remifentanil （2μg/kg）, midazolam（5 mg） and vecuronium bromide（0.12 mg/kg）. After tracheal intubation to drilling craniotomy, the patients pretreated with different drugs in group B, C, D and E. Blood lactic acid （LAD）, superoxide dismutase（SOD）, malondialdehyde （MDA） and neuron-specific enolase （NSE） content were measured before the pretreatment （T0, baseline）, at the end of surgery （T1）. The blood samples were taken at T0 and 24, 48 h（T2-3）, at 3 d （T4） after operation for measurement of white blood cells Interleukin-1 （IL-1）, tumor necrosis factor （TNF-α）, lactate dehydrogenase （LDH）, muscle phosphokinase （CPK）.ResultsCompared with T0, NSE content were higher in group T1（P〈0.05）. SOD, MDA increased in varying degrees, of which E group SOD and A group MDA increased with significant difference（P〈0.05）. There were no significant differences in LAD. Compared with T0, T2-T4 IL-1, TNF-α, LDH groups, CPK increased in varying degrees（P〈0.05）. Compared with group A, group E T2-T4 IL-1, TNF-α, LDH, CPK were statistically different（P〈0.05）. Compared with group E, B, C, D group, T4 IL-1, TNF-α, LDH, CPK values increased with significant difference（P〈0.05）.ConclusionThe pretreatment with all of propof

关 键 词：麻醉 脑损伤 再灌注 神经保护药 

分 类 号：R614[医药卫生—麻醉学]