摘要
背景:脑损伤后常引起继发性脑缺血、缺氧,使脑损害加重。颅脑手术可引起血浆氧自由基水平的升高,有可能加重对脑的损伤。异丙酚作为较新的用于麻醉诱导和麻醉维持的药物,其脑保护作用尤为引人注目。目的押观察异丙酚对急性颅脑损伤患者手术期间血清S100B的影响,分析其与患者6个月后简易智能量表评分的相关性,评价异丙酚的脑保护作用。设计:随机同期对照观察。单位:解放军广州军区武汉总医院麻醉科、神经外科和中心实验室,武汉大学中南医院麻醉学教研室。对象:于2004-01/06选择解放军广州军武汉总医院神经外科急性颅脑损伤患者30例为观察对象。随机数字表法分为异丙酚组和异氟醚组,每组15例。方法押患者在全麻下行开颅血肿或穴和雪挫裂伤灶清除术。异丙酚组术中用异丙酚4～8mg/(kg·h)泵注,芬太尼1.0～2.0μg/(kg·h)、维库溴铵0.02～0.03mg/(kg·h)静注维持麻醉。异氟醚组术中用异氟醚0.8～1.2MAC吸入,芬太尼1.0～2.0μg/(kg·h)、维库溴铵0.02～0.03mg/(kg·h)静注维持麻醉。通过酶联免疫吸附方法测定手术前、手术开始2h、手术结束时血清S100B含量。术后6个月按简易智能量表的定位、记录、注意力和计算力、记忆、语言及空间感等6个方面12项指标对接受随访的23例患者进行评分并记录。简易智能量表量表总分30分,分数越高表明智能越好。主要观察指标:两组患者手术期间各时段脑损伤标志物S100B的变化和6个月后简易智能量表评分以及两者的相关性。结果押30例患者所有受检血样均符合实验要求。6个月后随访,异丙酚组3例死亡,异氟醚组4例死亡,共有23例患者接受随访并进行简易智能量表评分。①开颅手术2h和手术结束时两组患者血清S100B均较术前有升高,手术结束时异丙酚组S100B显著低于异氟醚组,差异有显著性意义穴P<0.05雪;手术前、手术开始2h、手术结束时S100B呈一持续升高的过程。②异丙酚组简易智能量表评分高于异氟醚组,差异无显著性意义眼(22.33±5.96),(19.91±6.13)分,t=0.9603熏P>0.05演。③手术结束时S100B含量与6个月后简易智能量表评分呈显著负相关穴r=-0.487,P<0.05雪。结论押临床麻醉剂量的异丙酚可能降低手术期间S100B的升高,并有可能改善患者术后6个月认知能力,减少智力障碍的发生。
BACKGROUND： Brain injury often causes secondary cerebral ischemia and hypoxia, which aggravate the brain damages. Cerebral surgery can induce the increase of oxygen free radical in plasma, which may aggravate brain damage. As a new drug to induce and maintain anesthesia, the role of propofol in brain protection is more conspicuous.
OBJECTIVE： To observe the effect of propofol on the serum concentration of S100B in patients undergoing neurosurgery, analyze its relation with the score of mini-mental state examination （MMSE） after 6 months, and evaluate the brain protective effects of propofol.
DESIGN： A randomized and concurrent controlled trail.
SETTINGS： Department of Anesthesiology, Department of Neurosurgery, Central Laboratory, Wuhan General Hospital of Chinese PLA; Staff Room of Anesthesiology, Zhongnan Hospital of Wuhan University.
PARTICIPANTS： Thirty patients with acute craniocerebral injury, who were randomly selected from the Department of Neurosurgery, Wuhan General Hospital of Chinese PLA from January to June 2004, were divided into propofol group （n=15） and isoflurane group （n=15） according to the method of random number table.
METHODS： The patients accepted the removal of intracranial hematoma and/or focal cerebral contusion and laceration by craniotomy under general anesthesia. In the propofol group, the patients were pumped with propofol （4-8 mg/kg per hour） perioperatively, and the anesthesia was maintained with intravenous injections of fentanvl （1-2 μg/kg per hour） and vecuronium （0.02-0.03 mg/kg per hour）. In the isoflurane group, the patients inhaled isoflurane （0.8-1.2 MAC） perioperatively, and the anesthesia was maintained with intravenous injections of fentanvl （1-2 μg/kg per hour） and vecuronium （0.02-0.03 mg/kg per hour）. The serum concentration of S100B was detected with enzyme-linked immunoabsorbent assay （ELISA） before operation, at 2 hours after the beginning of the operation and at the end of the operation respectively. After 6 months, 23 patients were evaluated by the indexes of localization, recordance, calculation and attention, memory, speech and spatial sense in MMSE, and the scores were recorded. The total score of MMSE was 30 points, the higher the scores, the better their intelligence.
MAIN OUTCOME MEASURES： The changes of the brain injury marker of S100B at each time point perioperatively, MMSE scores at 6 months postoperatively, and the correlation between them were mainly observed in both groups.
RESULTS： The blood samples of the 30 patients were all involved. For the follow-up after 6 months, 3 and 4 cases died in the propofol group and isoflurane group respectively, and totally 23 patients were followed up and evaluated by MMSE. ① The serum S100B at 2 hours perioperatively and that at the end of the operation were increased as compared with the preoperative one in beth groups; At the end of the operation, it was significantly lower in the propofol group than in the isoflurane group （P 〈 0.05）. The S100B showed an ascending process before the operation, at 2 hours after the beginning of the operation and at the end of the operation. ② The MMSE score in the propofol group was not significantly higher than that in the isoflurane group [（22.33±5.96）, （19.91±6.13）, t=0.9603, P 〉 0.05）. ③ The S100B content at the end of the operation had a significant negative correlation with the MMSE score after 6 month （r=-0.487, P 〈 0.05）.
CONCLUSION： The clinical anesthetic dose of propofol can reduce the increase of the serum concentration of S100B perioperatively, ameliorate the cognitive ability of the patients at 6 months postoperatively, and attenuate the occurrence of dysnoesia.
出处
《中国临床康复》
CSCD
北大核心
2006年第46期178-181,共4页
Chinese Journal of Clinical Rehabilitation
