不同麻醉深度对颅内动脉瘤夹闭术中脑保护作用的影响  

Effect of different depth of anesthesia on cerebral protection during intracranial aneurysm clipping

作　　者：李三亮 石海红 许海静 闫军美 陈华永 LI Sanliang;SHI Haihong;XU Haijing;YAN Junmei;CHEN Huayong(Hospital Affiliated to Weifang Medical College,Qingzhou 262500,China)

机构地区：[1]潍坊医学院附属益都中心医院,山东青州262500

出　　处：《实用医学杂志》2018年第19期3260-3263,共4页The Journal of Practical Medicine

摘　　要：目的探讨不同麻醉深度对行颅内动脉瘤夹闭术中的脑保护作用的影响,以期为麻醉深度的选择提供参考。方法选取2015年6月至2017年6月我院收治的行颅内动脉瘤夹闭术患者作为研究对象。根据实施麻醉深度的不同将患者分为浅麻醉组和深麻醉组,分析比较两组患者术中不同时间点血清中丙泊酚、S100-β蛋白和NSE浓度,比较两组患者手术前后MMSE量表评分。结果浅麻醉组术中各时间点外周血丙泊酚水平均低于深麻醉组,差异具有统计学意义(P <0.05),但两组变化趋势一致。术中2h内深麻醉组患者外周血S100-β蛋白水平高于浅麻醉组,差异具有统计学意义(P <0.05);术中2 h以后深麻醉组外周血S100-β蛋白水平低于浅麻醉组,差异具有统计学意义(P <0.05)。麻醉诱导后浅麻醉组患者外周血NSE水平显著高于深麻醉组,差异具有统计学意义(P <0.05)。术前两组患者MSE量表评分差异无统计学意义(P> 0.05),术后深麻醉组患者MSE量表评分高于浅麻醉组,差异具有统计学意义(P <0.01)。结论深麻醉方案可减轻动脉瘤夹闭术中麻醉对脑组织的损伤程度,加速患者术后恢复,值得临床推广应用。Objective To investigate the effect of different depths of anesthesia on cerebral protection during intracranial aneurysm clipping in order to provide reference for the choice of depth of anesthesia.Methods Patients with intracranial aneurysm occlusion in our hospital from June 2015 to June 2017 were selected as the study subjects.Patients were divided into the shallow anesthesia group and the deep anesthesia group according to the depth of anesthesia.Propofol,S100-βprotein and NSE concentration were determined at different time points after operation in two groups.The MMSE score was compared between the two groups before and after operation.Results Compared with the deep anesthesia group,the level of propofol in the peripheral blood of patients in the shallow anesthesia group was significantly lower than that in the deep anesthesia group at each time point(P<0.05,respectively).The level of S100-βprotein in the deep anesthesia group was higher than that in the shallow anesthesia group within 2 hours after operation,with significant difference(P<0.05).The level of S100-βprotein in the deep anesthesia group was lower than that in the shallow anesthesia group at 2 hours after operation,with significant difference(P<0.05).The level of NSE in the peripheral blood of patients in the shallow anesthesia group after induction of anesthesia was significantly higher than that in the deep anesthesia group(P<0.05).No significant difference in MSE scale scores was observed between the two groups before operation.The postoperative MSE score of in the deep anesthesia group was significantly higher than that in the shallow anesthesia group(P<0.01).Conclusion The deep anesthesia regimen can reduce the degree of damage to brain tissue caused by anes-thesia during aneurysm clipping and accelerate the recovery of patients after operation,which is worthy for clinical application.

关 键 词：麻醉深度 动脉瘤夹闭术 动脉瘤 脑保护 脑损伤 

分 类 号：R651.1[医药卫生—外科学]