甘国胜 1王焱林 2王成夭 2陈利民 1陈敏 1张小军 3丘伟4
作者信息
- 1. 解放军广州军区武汉总医院麻醉科,湖北省,武汉市,430070
- 2. 武汉大学中南医院麻醉学教研室,湖北省,武汉市,430071
- 3. 解放军广州军区武汉总医院神经外科,湖北省,武汉市,430070
- 4. 解放军广州军区武汉总医院中心实验室,湖北省,武汉市,430070
- 折叠
摘要
Abstract
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 both 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.关键词
异丙酚/颅脑损伤/问卷分类
医药卫生
