机构地区:[1]空军军医大学第二附属医院麻醉科,西安710038
出 处:《中国医师杂志》2025年第1期33-37,共5页Journal of Chinese Physician
基 金:国家自然科学基金(81801391)。
摘 要:目的探讨丙泊酚麻醉维持与患者开颅手术后脑组织水肿的关系及对患者的脑保护作用。方法选取2022年6月—2023年6月在空军军医大学第二附属医院接受开颅手术的98例患者,按随机数字表法分为对照组和观察组,每组49例。对照组气管插管后吸入七氟醚维持麻醉,观察组气管插管后静脉泵注丙泊酚维持麻醉。比较两组患者脑组织水肿的动态变化、颅内压、脑损伤因子[S100钙化蛋白β(S100-β)、神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)]、脑氧代谢指标[动静脉血氧含量差(AVDO_(2))、动静脉血乳酸差(AVDL)、脑氧代谢率(CMRO_(2))]、氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)和谷胱甘肽过氧化物酶(GSH-Px)]。结果两组患者术前脑组织水肿程度、颅内压、脑损伤因子、脑氧代谢指标、氧化应激指标比较,差异均无统计学意义(均P>0.05)。两组患者术后的脑组织水肿程度、颅内压、脑损伤因子、脑氧代谢指标、氧化应激指标与术前比较,差异均有统计学意义(均P<0.05)。观察组患者术后24 h和72 h的脑组织水肿程度均轻于对照组,差异有统计学意义(均P<0.05)。观察组患者颅骨切开后、颅骨复位前、手术结束后的颅内压均低于对照组,差异有统计学意义(均P<0.05)。观察组患者颅骨切开后、颅骨复位前、手术结束后的血清S100-β、NSE、GFAP水平均低于对照组,差异有统计学意义(均P<0.05)。观察组患者颅骨切开后、颅骨复位前、手术结束后的AVDO_(2)、AVDL、CMRO_(2)均优于对照组,差异有统计学意义(均P<0.05)。观察组患者颅骨切开后、颅骨复位前、手术结束后的MDA水平低于对照组,SOD和GSH-Px水平高于对照组,差异有统计学意义(均P<0.05)。结论丙泊酚麻醉维持可以减轻患者开颅手术后的脑组织水肿,降低颅内压,减少脑损伤因子的释放,改善脑氧代谢,增强抗氧化能力,对患者的脑保护�Objective To investigate the relationship between propofol anesthesia maintenance and cerebral tissue edema after craniotomy and its protective effect on the brain.MethodsA total of 98 patients who received craniotomy in the Second Affiliated Hospital of Air Force Medical University from June 2022 to June 2023 were selected and divided into control group and observation group according to random number table method,with 49 cases in each group.Sevoflurane was inhaled to maintain anesthesia in the control group after tracheal intubation,and propofol was injected intravenously into the observation group after tracheal intubation.The indexes were compared between the two groups in terms of dynamic changes of cerebral tissue edema,intracranial pressure,brain injury factors[S100 calcified proteinβ(S100-β),neuron-specific enolase(NSE),glial fibrillary acidic protein(GFAP)],cerebral oxygen metabolism indexes[arterial blood oxygen content(AVDO_(2)),arterial blood lactic acid(AVDL),cerebral oxygen metabolism rate(CMRO_(2))],oxidative stress indicators[malondialdehyde(MDA),superoxide dismutase(SOD)and glutathione peroxidase(GSH-Px)].ResultsThere were no significant differences in the degree of cerebral tissue edema,intracranial pressure,brain injury factors,cerebral oxygen metabolism indexes and oxidative stress indexes between the two groups(all P>0.05).There were significant differences in the degree of cerebral tissue edema,intracranial pressure,brain injury factors,cerebral oxygen metabolism indexes and oxidative stress indexes between the two groups after surgery(all P<0.05).The degree of cerebral edema in the observation group at 24 h and 72 h after operation was less than that in the control group,and the difference was statistically significant(all P<0.05).The intracranial pressure after craniotomy,before skull reduction and after operation in the observation group was lower than that in the control group,with statistical significance(all P<0.05).The serum levels of S100-β,NSE,GFAP in observation group were lower
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