远程缺血预处理对神经外科手术的脑保护作用的研究随机、双盲、单中心平行对照

发布时间：2019-06-06 04:43

【摘要】： 背景 脑膜瘤是临床上的常见病,约占临床上脑肿瘤15%,其组织病理大多为良性表现,具有生长缓慢侵袭性较小的特点。虽然有多种方法可以用于脑膜瘤的治疗,但手术切除脑膜瘤是唯一有效的方法,临床上手术切除肿瘤时硬脑膜切开导致的脑组织肿胀和肿瘤切除减压可导致脑组织缺血再灌注损伤,严重影响患者的预后和生命安全。虽然已有实验证实缺血预处理具有减轻脑缺血再灌注损伤的作用,但是其临床应用的不可操作性和创伤性限制了其临床应用。非缺血预处理的方法中已经证实高压氧,电针和吸入麻醉剂等预处理方法可以减轻缺血再灌注损伤,但在临床应用中具有一定的局限性。许多动物实验研究已证实远程缺血预处理具有减轻心、脑、肝、肾、脊髓等器官的缺血再灌注损伤作用。最近一系列临床随机对照试验研究也证实,远程缺血预处理可减轻心血管手术时心肌的缺血再灌注损伤。这对我们预防脑膜瘤切除手术后产生的脑缺血再灌注损伤提供了新的思路。由于远程缺血预处理具有方便安全、无创伤且临床操作简便易行等优点。设计本研究旨在探讨远程缺血预处理对脑膜瘤切除术后脑缺血再灌注损伤的保护作用,为将来其大规模临床应用提供科学依据。 目的 通过对围术期脑组织损伤具有特异性的生化指标的观察和神经功能评分,探讨远程缺血预处理对脑膜瘤切除术后脑缺血再灌注损伤的保护作用。 方法 56例择期行脑膜瘤切除术的脑膜瘤患者在麻醉诱导前随机分成两组:远程缺血预处理组26例和对照组30例。远程缺血预处理参照文献使用充气式止血带对右上肢实施3次5分钟缺血5分钟再灌注,充气压力为200mmHg。对照组只放置止血带,不进行充气。两组患者均行L4—5穿刺置管抽取脑脊液。分别于麻醉诱导前、诱导后预处理前、硬脑膜切开前、硬脑膜切开后4小时,24小时,3天和7天采集血液标本检测血清S-100B和神经元特异性烯醇化酶(NSE)的浓度,检测诱导后预处理前、硬脑膜切开前及硬脑膜切开后4小时和24小时的脑脊液S-100B和神经元特异性烯醇化酶(NSE)的浓度。并于术前及术后2天和术后7天对患者神经功能学进行评分。 结果 1.对血清生化指标的影响。生化指标检测表明预处理组血清NSE水平在硬脑膜切开后4和24小时与对照组相比较明显降低(P0.05)。 2.对脑脊液血清生化指标的影响。脑脊液中预处理组硬脑膜切开后4小时和24小时NSE和S100B的浓度与对照阻闭较均明显降低(P0.05)。 3.预处理组的神经功能学评分在术后2天和7天均好于对照组。 结论 本研究结果证实,远程缺血预处理对脑膜瘤切除术后脑缺血再灌注损伤具有保护作用,可以改善患者的预后提高术后生活质量。这项新的研究结果为将来远程缺血预处理在临床脑膜瘤切除术中的应用提供理论和临床依据。
[Abstract]:Background meningioma is a common clinical disease, accounting for about 15% of clinical brain tumors. Most of its histology is benign and has the characteristics of slow growth and small invasiveness. Although there are many methods that can be used in the treatment of meningioma, surgical resection of meningioma is the only effective method. The swelling of brain tissue caused by dural incision and decompression during surgical resection of tumor can lead to cerebral ischemia-reperfusion injury, which seriously affects the prognosis and life safety of patients. Although ischemic pretreatment has been proved to be effective in reducing cerebral ischemia-reperfusion injury, its clinical application is inoperable and traumatic, which limits its clinical application. It has been proved that hyperbaric oxygen, electro-acupuncture and inhaled anesthetics can reduce ischemia-reperfusion injury in non-ischemic pretreatment, but it has some limitations in clinical application. Many animal experiments have confirmed that remote ischemic pretreatment can alleviate ischemia-reperfusion injury in heart, brain, liver, kidney, spinal cord and other organs. A series of recent clinical randomized controlled trials have also confirmed that remote ischemic pretreatment can reduce myocardial ischemia-reperfusion injury during cardiovascular surgery. This provides a new way for us to prevent cerebral ischemia-reperfusion injury after meningioma resection. Remote ischemic pretreatment has the advantages of convenience, safety, non-trauma and simple clinical operation. The purpose of this study was to investigate the protective effect of remote ischemic preprocessing on cerebral ischemia-reperfusion injury after meningioma resection, and to provide scientific basis for its large-scale clinical application in the future. Objective to investigate the protective effect of remote ischemic pretreatment on cerebral ischemia-reperfusion injury after meningioma resection by observing the specific biochemical indexes and neurological function score of perioperative brain tissue injury. Methods 56 patients with meningioma undergoing elective meningioma resection were randomly divided into two groups: remote ischemic pretreatment group (n = 26) and control group (n = 30). The right upper limb was treated with inflatable tourniquet for 3 times for 5 minutes, ischemia for 5 minutes and reperfusion for 5 minutes, and the inflatable pressure was 200 mm / kg 路L ~ (- 1) 路L ~ (- 1). The control group only placed tourniquet, not inflated. Cerebrospinal fluid (cerebrospinal fluid) was extracted by L 4 鈮，

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