丙泊酚联合利多卡因在颅脑肿瘤手术麻醉预处理中的应用及对神经功能的影响  

Application and effect on neurological function of propofol combined with lidocaine in the anesthetic pretreatment in patients with craniocerebral tumor surgery

作　　者：王威 崔崇英 辛开荣 田家齐[3] 李金矿[2] 李家凤[4] WANG Wei;CUI Chong-ying;XIN Kai-rong;TIAN Jia-qi;LI Jin-kuang;LI Jia-feng(Department of Anesthesiology;Department of Ultrasound Imaging;Department of Cardiovascular Medicine;Department of Psychiatry,Zhongxiang People＇s Hospital of Hubei Province,Zhongxiang 431900,China)

机构地区：[1]钟祥市人民医院麻醉科,湖北钟祥431900 [2]钟祥市人民医院超声影像科,湖北钟祥431900 [3]钟祥市人民医院心血管内科,湖北钟祥431900 [4]钟祥市人民医院精神医学科,湖北钟祥431900

出　　处：《中国耳鼻咽喉颅底外科杂志》2018年第5期446-450,458,共6页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：湖北省卫生和计划生育委员会课题(WJ2017F097);湖北荆门市引导性科研计划项目(YDKY 2017056)

摘　　要：目的分析丙泊酚联合利多卡因在颅脑肿瘤手术麻醉预处理中的应用价值及对神经功能的影响。方法应用前瞻性研究和随机数字表法选取90例需手术治疗的颅脑肿瘤患者,根据麻醉预处理方式不同将患者分为观察组和对照组,两组均经丙泊酚麻醉预处理,观察组在对照组基础上加用利多卡因。对比两组患者手术前后神经功能缺损量表(NFA)、运动功能测评(FMA)、日常生活活动能力指数(Barthel)及汉密尔顿抑郁量表(HAMD)得分;同时检测两组患者手术前后超氧化物歧化酶(SOD)及神经元特异性烯醇化酶(NSE)、白介素-1(IL-1)、肿瘤坏死因子-α(TNF-α)水平,并进行比较。结果 (1)术前观察组与对照组组间NFA、FM以及Barthel、HAMD比较差异无统计学意义(P> 0. 05);观察组术前术后组内NFA、FMA比较差异有统计学意义,NFA升高,FMA降低(P <0. 05);对照组术前术后组内NFA、FMA比较差异有统计学意义,NFA升高,FMA降低(P <0. 05);术后观察组与对照组组间NFA、FMA比较差异均有统计学意义(P <0. 05),观察组NFA更低,FMA更高。观察组术前术后组内Berthel、HAMD分值比较差异有统计学意义(P <0. 05),Barthel降低,HAMD升高;对照组术前术后组内Berthel、HAMD分值比较差异有统计学意义(P <0. 05),Barthel降低,HAMD升高;术后观察组与对照组组间Barthel、HAMD比较差异有统计学意义(P <0. 05),观察组Barthel较对照组高,HAMD分值较对照组低;(2)术前观察组与对照组组间SOD、NSE、IL-1、TNF-α比较差异无统计学意义(P> 0. 05);观察组术前术后组内SOD、NSE、IL-1、TNF-α比较差异均有统计学意义(P <0. 05),SOD、NSE升高,IL-1、TNF-α降低;对照组术前术后组内SOD、NSE、IL-1、TNF-α比较差异均有统计学意义(P <0. 05),SOD、NSE升高,IL-1、TNF-α降低;术后观察组与对照组组间SOD、NSE、IL-1、TNF-α比较差异有统计学意义(P <0. 05),观察组SOD、NSE、IL-1、TNF-α较对照组低。结论采用丙Objective To investigate the application value and effect on neurological function of propofol combined with lidocaine in the anesthetic pretreatment in patients with craniocerebral tumor surgery. Methods 90 patients with craniocerebral tumors undergoing surgical treatment were enrolled in this prospective study. All the patients were randomly divided into control group and observation group. The patients in both groups received anesthetic pretreatment with propofol,while lidocaine was added to those of the observation group. Before and after operation,evaluations including neurological function deficits assessment（ NFA）,Fugl-Meyer motor function assessment（ FMA）,Barthel Index（ BI） and Hamilton depression rating scales（ HAMD） were performed in all patients of both groups. Meanwhile,their pre-and postoperative serum levels of superoxide dismutase（ SOD） and neuron specific enolase（ NSE）,IL-1,TNF-α were detected. All the results were compared. Results（1）The preoperative score differences of NFA,FMA,BI and HAMD between the observation group and the control group were statistically insignificant（ all P〉0. 05）. The differences between the preoperative scores of NFA,FMA and the postoperative ones in both groups were all statistically significant（ all P 0. 05）,with increased NFA and decreased FMA. The differences of postoperative scores of NFA,FMA between the observation group and the control group were statistically significant（ both P〈0. 05）,with lower NFA and higher FMA in the observation group. The differences between the preoperative scores of BI,HAMD and the postoperative ones in both groups were all statistically significant（ all P〈0. 05）,with increased HAMD and decreased BI. The differences of postoperative scores of BI,HAMD between the observation group and the control group were statistically significant（ both P 0. 05）,with lower HAMD and higher BI in the observation group;（2）The preoperative serum level differences of SOD,NSE,IL-1 and TNF-α between th

关 键 词：麻醉预处理 颅脑手术 丙泊酚 利多卡因 神经损伤 

分 类 号：R739.41[医药卫生—肿瘤]