摘要
目的探讨异丙酚+瑞芬太尼对前交通动脉瘤夹闭术患者血流代谢及血清β蛋白(S100β)、神经元特异性烯醇化酶(NSE)含量的影响。方法全麻下行颅内动脉瘤夹闭术患者56例,麻醉危险度(ASA)分级Ⅰ或Ⅱ级。采用随机数字表法,将其随机分为两组。治疗组29例,对照组27例。治疗组患者采用异丙酚+瑞芬太尼维持麻醉,对照组患者采用异丙酚维持麻醉。全静脉麻醉维持深度,监测插管即刻(t_0)、硬脑膜切开前(t_1)、动脉瘤夹闭前(t_2)、动脉瘤夹闭即刻(t_3)、和手术结束时(t_4)的各时间点其血流动力学变化情况,包括心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_2)、动脉血氧分压(PO_2)、颈内静脉球氧饱和度(SjvO_2)、动脉血乳酸浓度(La)、静脉血乳酸浓度(Ljv)、动、静脉血乳酸浓度差(DLjv-a),两组同步抽外周静脉血5 mL,应用酶联免疫(ELISA)法对患者的血清SI00β蛋白、NSE含量进行检测。结果治疗组患者在t_0、t_1、t_2时点血压(BP)、HR较对照组患者明显降低(P<0.05);在t_3、t_4这2个时点颈内静脉球氧含量差(Da-jvO_2),较对照组患者明显升高,SjvO_2明显降低,但在整个手术过程中t_0、t_1、t_2、t3、t_4各时间点血流动力学状态稳定,波动幅度较对照组小。S100β蛋白、NSE含量较对照组明显降低(P<0.05)。结论异丙酚联合瑞芬太尼可改善动脉瘤夹闭术患者血液流变状态,增加脑含氧量。降低血液中S100β蛋白、NSE含量,减少神经损害,起到脑保护作用。
Objective The effects of propofol and remifentanil on blood flow metabolism and serum levels of S100β and neuron-specific enolase （NSE） in patients with anterior aneurysm clipping were discussed. Methods Fifty-six patients undergeing occlusion of intracranial aneurysm under general anesthesia were divided into two groups according to ASA Grade I or II. They were randomly divided into two groups by random number table method with 29 cases in the treatment group and 27 cases in the control group. The patients in the treatment group were given propofol plus remifentanil to maintain anesthesia and for those in the control group propofol were given. Total intravenous anesthesia was maintained at various depths. The hemodynamic changes were detected at the duration of intubation （t0 ）, dural incision （t1）, aneurysm occlusion （ t2 ）, aneurysm occlusion immediately （t3 ）, and end of surgery （HR）, respectively, and the indices including mean arterial pressure （MAP）, blood oxygen saturation （SpO2 ）, arterial oxygen pressure （PO2 ）, internal jugular vein oxygen saturation （SjvO2 ）, lactic acid concentration （La）, lactate concentration （Ljv）, dynamic and venous blood lactic acid concentration difference （DLjv-a） were recorded. A total of 5 mL peripheral blood venous blood of two groups were synchronously drawn to detect the NSE levels and serum S10013 protein by enzyme-linked immunosorbent assay （ELISA）. Results The blood pressure （BP） and HR of the treatment group were significantly lower than those of the control group at to, t1 and t2 （P 〈0.05）. The content of internal jugular bulb oxygen content difference （Da-jvO2） was increased significantly compared with the control group and SjvO2 was significantly decreased at t3 and t4. However, the hernodynamic status maintained stable at all time points, and the fluctuation range was smaller than those of the control group. S100β protein and NSE levels were significantly lower than those in the control group （P 〈 0. 05）. Conclusion Propofol combined with remifentanil can itrrprove the blood rheology and increase the cerebral oxygen content in patients with aneurysm clipping, reduce the blood S100β protein and NSE content, decrease the nerve damage, accordingly play a role in brain protection.
出处
《中华神经外科疾病研究杂志》
CAS
2018年第1期39-42,共4页
Chinese Journal of Neurosurgical Disease Research
作者简介
王海燕，副主任医师，E—mail：wanghaiyan20000@163．com;通讯作者：张军，副主任医师，E-mail：825663432@qq．com
