摘要
目的探讨异丙酚后处理对颅内动脉瘤夹闭术患者脑缺血再灌注时脑组织抗氧化作用的影响。方法择期拟行颅内动脉瘤夹闭术患者30例，年龄26～64岁，体重53～73kg，ASAⅠ或Ⅱ级，随机分为2组（n=15）：对照组（C组）和异丙酚后处理组（P组）。C组吸入0．5％～2．0％七氟烷，P组在开放载瘤动脉前吸入0．5％～2．0％七氟烷，开放载瘤动脉即刻靶控输注异丙酚至术毕，血浆靶浓度设为1．2μg／ml，同时下调七氟烷吸入浓度，维持BIS40～60。于麻醉诱导前即刻（R）、阻断载瘤动脉即刻（T1）、开放载瘤动脉即刻（T2）、开放载瘤动脉后30min（T3）、1h（T4）及术毕（T5）时测定脑脊液压力，于T0、T3、T5及术后24h（T6）时测定脑脊液F2-异前列腺素（F2-IsoPs）、α-生育酚（α—T）及γ-生育酚（γ-T）的浓度。结果与T0时比较，T4-5时C组脑脊液压力降低，T3-5时P组脑脊液压力降低，T3,5,6时两组脑脊液α-T及γ-T的浓度降低，F2-IsoPs浓度升高（P〈0．05）；与C组比较，P组T3．4时脑脊液压力降低，T3,5,6时γ-T浓度升高，F2-IsoPs浓度降低（P〈0．05）。结论异丙酚后处理可增强颅内动脉瘤夹闭术患者脑缺血再灌注时脑组织的抗氧化作用。
Objective To investigate the effect of TCI of propofol （Cp 1.2μg/ml） starting from the end of temporary occlusion of the cerebral artery and maintained until the end of operation on antioxidative effects of brain during cerebral isehemia-reperfusion injury in patients undergoing elective clipping of intraeranial aneurysm. Methods Thirty ASA Ⅰ or Ⅱ patients, aged 26-64 yr, weighted 53-73 kg, undergoing elective intraeranial aneurysm clipping were randomly divided into 2 groups （n = 15 each）： control group （group C） and propofol posteonditioning （group P） . A catheter was placed in the subaraehnoid space at L3,4 interspace for CSF pressure monitoring and collection of CSF samples. Radial artery was eannulated for MAP monitoring. ECG, HR, MAP, SpO2, PET CO2 and BIS were continuously monitored. Anesthesia was induced with midazolam, propofol, fentanyl and roeuronium and maintained with 0.5 %-2.0% sevoflurane, iv infusion of fentanyl and intermittent iv boluses of veeuronium. In group P TCI of propofol （Cp 1.2 μg/ml） was started from the end of temporary occlusion of cerebral artery and maintained until the end of operation. Meanwhile the sevoflurane concentration was decreased and BIS was maintained at 40-60. CSF pressure was measured before induction of anesthesia （T0 ）, immediately after occlusion of cerebral artery （ T1 ）, immediately （T2 ） and at 30 min （ T3 ） and 1 h （ T4 ） after removal of cerebral artery occlusion and at the end of operation （T5 ）. CSF concentrations of F2-isoprostanees （F2-IsoPs） （by ELISA） and α- and γ-tocopherol （α-T, γ-T） were measured at T0 , T3 , T5 and 24 h after operation （T6 ） .Results CSF pressure was significantly lower at T3 and T4 in group P than in group C. The CSF concentrations of α-T and γ-T were significantly decreased at T3 ,T5 and T6 as compared with the baseline at To in both groups. There was no significant difference in α-T concentration between the two groups; while the γ-T concentration in CSF was significantly higher at T3, T5 and T6 in group P than in group C. The CSF concentrations of F2-IsoPs were significantly increased at T3 , T5 and T6 as compared with the baseline at To in both groups and were significantly lower in group P than in group C. Conclusion TCI of propofol with Cp at 1.2 μg/ml starting from the end of temporary cerebral artery occlusion and maintained until the end of operation can enhance the antioxidative effects of brain in patients undergoing clipping of intracranial aneurysm.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2010年第2期188-191,共4页
Chinese Journal of Anesthesiology
基金
天津医科大学科学基金（2006ky39）
关键词
二异丙酚
再灌注损伤
脑
氧化还原
Propofol
Reperfusion injury
Brain
Oxidation-reduction
