麻醉药物联合控制降压对颅脑手术患者脑脂质过氧化的影响

发布时间：2018-07-03 03:40

  本文选题：瑞芬太尼 + 七氟烷　； 参考：《石河子大学》2017年硕士论文

【摘要】：目的:探讨在颅脑手术患者中不同麻醉药物之间两两联合进行控制性降压对脑脂质过氧化损伤的影响。方法:选择全身麻醉下择期行开颅颅内占位切除术的神经胶质瘤患者(术后病理切片已确诊)120例为研究对象。将所有患者随机分为四组进行控制性降压(CH):瑞芬太尼+七氟烷(RS)组、瑞芬太尼+丙泊酚(RP)组、七氟烷+丙泊酚(SP)组、硝酸甘油(N)组。所有患者均在剪开硬脑膜后开始实施CH,各组患者平均动脉压(MAP)均在10分钟内下降术前基础值的30%。手术医师关闭硬脑膜后停止实施CH。所有患者均连续监测平均动脉压(MAP)、心率(HR)及局部脑氧饱和度(r Sc O2),并分别于全麻诱导前(T1)、使用头皮拉钩固定头皮后(T2)、CH开始后10分钟(T3)、CH开始后30分钟(T4)、CH停止后30分钟(T5)五个时间点记录。同时,分别于五个时间点采集颈内静脉血和桡动脉血各3ml至真空试管,迅速置于-80℃冰箱内以备检测超氧化物歧化酶(SOD)活性和丙二醛(MDA)含量,并于T4时间点记录脑电双频指数(BIS)及术野质量评分(SSFQ)。结果:各组组内比较,T3、T4、T5较T1时间点动脉、静脉中SOD活性明显下降(P0.05),而静-动脉之差则呈增大趋势(P0.05)。在T3、T4、T5时间点,N组较RP组、RS组、SP组动脉、静脉中SOD活性明显减少(P0.05),静-动脉之差则明显增大(P0.05)。在T4时间点,RP组较RS组、SP组,SOD活性静-动脉之差明显增大(P0.05),而RS组与SP组之间则差异无统计学意义(P0.05)。各组组内比较,T3、T4、T5较T1时间点动脉、静脉中MDA含量及静-动脉之差均呈明显上升趋势(P0.05)。在T3、T4、T5时间点,N组较RP组、RS组、SP组静脉中MDA含量及静-动脉之差均呈明显增加(P0.05)。在T4时间点,RP组较RS组、SP组,静脉MDA含量及静-动脉之差呈明显增加(P0.05),而RS组与SP组之间则差异无统计学意义(P0.05)。T3、T4较T1、T2、T5时间点,各组r Sc O2均有明显下降(P0.05)。各组之间比较差异无统计学意义(P0.05)。与RP组、RS组比较,SP组BIS值明显下降(P0.05),而N组BIS值则明显上升(P0.05),同时N组在SSFQ评分上较其余三组也呈明显升高(P0.05)。结论:与使用硝酸甘油进行CH相比,在颅脑手术中,使用瑞芬太尼、七氟烷、丙泊酚三种麻醉药物两两联合实施CH,即可以在保证患者安全的前提下,减少术野出血满足手术需求,同时也可以减低脑组织中MDA的含量,增加SOD的活性,发挥脑保护的作用。相较于丙泊酚联合瑞芬太尼或七氟烷两组CH方案,瑞芬太尼联合七氟烷对脑脂质过氧化损伤的减轻程度更加明显,且不会加大麻醉深度,是一种安全可靠的CH方案,可以应用于临床颅脑手术当中。
[Abstract]:Aim: to investigate the effect of controlled hypotension between different anesthetic drugs on brain lipid peroxidation injury in patients undergoing craniocerebral surgery. Methods: 120 patients with glioma underwent selective craniotomy under general anesthesia (confirmed by pathological section after operation) were selected. All patients were randomly divided into four groups: remifentanil sevoflurane (RS) group, remifentanil propofol (RP) group, sevoflurane propofol (SP) group and nitroglycerin (N) group. The mean arterial pressure (map) of all patients was decreased by 30% of the preoperative baseline value within 10 minutes. The surgeon closed the dura mater and stopped the administration of CH3. Mean arterial pressure (map), heart rate (HR) and regional cerebral oxygen saturation (r SC O 2) were continuously monitored in all patients before induction of general anesthesia (T1), and 30 minutes after Ch began (T 4) 30 minutes after Ch began with scalp retractor fixation (T 2). The clock (T 5) is recorded at five points in time. At the same time, the 3ml of internal jugular vein and radial artery were collected from five time points to vacuum tube, and then placed in the refrigerator at -80 鈩，

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