目的 观察异丙酚麻醉对脑外伤血肿清除术患者的脑保护作用。方法 脑外伤血肿清除术患者60例,随机均分为异丙酚组和依托咪酯组。分别于麻醉前(t0)、插管后(t1)、手术开始后1 h(t2)、手术开始后2 h(t3)记录颈内静脉球氧饱和度(SjvO2)并计算脑氧摄取率(CERO2)。分别于不同时间点:手术前(T0)、手术开始后1 h(T1)、术后1 h(T2)、术后24 h(T3)抽取颈内静脉血样,检测S100β蛋白含量。术后30 d记录患者的格拉斯哥预后评分(glasgow outcome scale, GOS)和简易智力状况检查评分(mini-mental state examination, MMSE)。结果 与t0时比较,t1、t2、t3时两组SjvO2明显升高(P＜0.05);异丙酚组t1、t2、t3时CERO2(30.9%±5.04%、30.2%±6.17%、 28.7%±3.21%)降低,依托咪酯组的CERO2在t1时(24.9%±4.31%)降低(P＜0.05);与依托咪酯组比较,异丙酚组t1、t2、t3时SjvO2明显升高,CERO2降低(P＜0.05)。患者S100β蛋白含量在T2时异丙酚组为(1.17±0.26)μg/L,小于依托咪酯组的(1.52±0.19)μg/L (P＜0.05)。两组GOS和MMSE评分没有统计学差异。结论 异丙酚在脑外伤血肿清除手术患者具有一定的脑保护作用。
Abstract
Objective To investigate the cerebral protective effects of propofol in patients with intracerebral hemorrhage during intracranial surgery.Methods Sixty patients with intracerebral hemorrhage were randomly divided into two groups (n=30 each): propofol group (P group) and etomidate group (E group). At four time points viz. before narcosis(t0), after induction(t1), 1 h after operation(t2), 2 h after operation(t3), jugular bulb venous oxygen saturation(SjvO2) were recorded, the cerebral oxygen uptake rate(CERO2) were calculated with the Fick formula. Venous blood samples were taken preoperatively(T0), 1 h after surgery(T1), postoperative 1 h(T2)and 24 h(T3) to test the neurological injury marker S100β.The GOS and MMSE tests 30 days after surgery were recorded.Results In two groups, SjvO2 were higher at t1,t2 and t3 when compared with t0. CERO2 (30.9%±5.04%,30.2%±6.17%, 28.7%±3.21%)were lower at t1,t2 and t3 in group P, the same was in group E(24.9%±4.31%) at t1 (P＜0.05). Compared with group E, in group P,SjvO2 was significantly higher at t1,t2 and t3 whereas the CERO2 was lower(P＜0.05). The level of S100β in group P (1.17±0.26)μg/L was lower than in group E (1.52±0.19)μg/L (P＜0.05)at T2. There was no differences in GOS and MMSET between the propofol group and etomidate group.Conclusions Propofol can improve the cerebral oxygen metabolism and reduce S100β level in blood but fails to improve the GOS and MMSET. The cerebral protection of propofol exists but does not reduce major neurological sequelae.
关键词
异丙酚 /
依托咪酯 /
脑保护 /
创伤性脑损伤
Key words
propofol /
etomidate /
cerebral protection /
traumatic brain injury
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