目的 观察丙泊酚和异氟烷两种麻醉药对急性颅脑外伤患者术后血清NSE、S100B蛋白、炎性因子及认知功能的影响。方法 选择2014-01至2015-12 符合标准的急性颅脑外伤患者98例,采取随机数字表法分成对照组和观察组,每组49例。两组患者均采用芬太尼、维库溴铵、依托咪酯行麻醉诱导,其中观察组静脉注射丙泊酚维持麻醉,对照组吸入异氟烷维持麻醉,比较两组术前、术中2 h、术毕、术后48 h血清S100B蛋白、神经元特异性烯醇化酶(NSE)含量,术前、术后48 h血清肿瘤坏死因子(TNF)-α、白介素(IL)-6水平,并于术后3个月、6个月采取简易精神状态检查量表(MMSE)对两组患者术后认知功能恢复情况进行对比。结果 两组患者术前血清S100B蛋白、NSE水平无统计学差异,对照组患者术中2 h、术毕、术后48 h血清S100B蛋白、NSE水平高于观察组(P<0.05)。两组患者术前血清TNF-α、IL-6水平无统计学差异,观察组患者术后48 h血清TNF-α、IL-6水平低于对照组(P<0.05)。两组患者术后3个月MMSE评分无统计学差异;观察组术后6个月MMSE评分明显高于对照组(P<0.01)。结论 与异氟烷吸入麻醉相比,丙泊酚静脉麻醉可有效降低急性颅脑外伤患者术后血清炎性因子水平,减轻颅脑损伤程度,改善患者认知功能。

Objective To explore the effect of propofol on serum NSE, S100B protein, inflammatory factors and cognitive function of patients with acute craniocerebral injury.Methods Ninety-eight patients who had been diagnosed with acute craniocerebral trauma and met criteria between January 2014 and December 2015 were selected. Using a random number table, they were equally divided into two groups and treated with fentanyl, vecuronium and etomidate for induction of anesthesia. The observation group received intravenous injection of propofol to maintain anesthesia while the control group received inhalation of isoflurane. Then, serum S100B protein and neuron specific enolase (NSE) content determined before operation, two hours into the operation, at the end of the operation and postoperative 48 h, and serum tumor necrosis factor TNF-α, interleukin IL-6 levels of preoperative and postoperative 48h were compared between the two groups. After 3 months and 6 months, the mini mental state examination scale (MMSE) was adopted to compare the neurological function recovery in the two groups after operation.Results The levels of serum S100B protein and NSE were not significantly different between the two groups before treatment. The serum S100B protein and NSE levels of the control group were higher than those of the observation group two hours into the operation, towards the end of surgery, and 48 hours after operation. There was no significant difference in serum IL-6 or TNF-α levels between the two groups before treatment but they were lower in the observation group than in the control group 48 hours after operation (P<0.05). The MMSE score of the two groups was not significantly different three months after operation, but was higher in the observation group than in the control group six months after operation (P<0.05).Conclusions Compared with isoflurane inhalation anesthesia, propofol intravenous anesthesia can effectively decrease the serum levels of inflammatory cytokines, reduce the degree of craniocerebral injury, and improve the cognitive function of patients with acute craniocerebral injury.