丙泊酚和异氟醚对脑肿瘤患者围手术期血清NO、NOS、MDA的影响

Effects of propofol and isoflurane on serum NO,NOS,MDA in patients undergoing brain tumor resection

目的观察脑肿瘤患者围手术期丙泊酚靶控输注和异氟醚静吸复合麻醉血清一氧化氮(NO)、NO合酶(NOS)、丙二醛(MDA)浓度的变化,比较两种麻醉方式对氧化损伤的影响.方法选择脑胶质瘤和脑膜瘤患者40例,ASA Ⅰ～Ⅱ级,随机分为异氟醚组(Ⅰ组,n=19)和丙泊酚组(P组,n=21).另设健康志愿者20人为对照组(N组).气管插管后行机械通气,O2/N2O 1:1吸入.Ⅰ组异氟醚1.5%～2%吸入,P组1%丙泊酚每50 ml加入芬太尼0.2 mg,靶控输注浓度为3～4μg/ml.间断静注维库溴铵40μg/kg维持肌松.监测HR、BP、脉搏血氧饱和度(SpO2)、中心静脉压、血糖、血气,维持SpO2在98%以上.N组清晨空腹抽取静脉血5 ml,P组与Ⅰ组于麻醉诱导前(T0)、诱导后1 h(T1)、开颅后1 h(T2)、3 h(T3)、6 h(T4)、24 h(T5)分别抽取静脉血5 ml,离心处理待测.结果与N组相比,P组、Ⅰ组T0时NO、NOS、MDA浓度显著升高(P<0.05);P组NO于T4、T5时以及NOS、MDA于T5时较T0时均显著降低(P<0.05);与Ⅰ组相比,P组在T3、T4、T5时NO、NOS、MDA浓度显著降低(P<0.05).结论丙泊酚靶控麻醉同异氟醚麻醉相比,能够显著地减轻脑肿瘤患者围手术期存在的氧化损伤.

Objective To study the perioperative changes of serum concentration of NO,NOS and MDA selected in patients undergoing cerebral tumor resection with propofol or isoflurane anesthesia.Methods Forty patients,ASAⅠ-Ⅱ,undergoing brain glioma or meningima resection. They were divided into propofol group(group P,n=21) and isofllurane group(group I,n=19) randomly.Twenty volunteers were selected as control group (group N,n=20). Patients in group P and I were induced by fentanyl 5μg/kg, midazolam 40μg/kg, vecuronium 0.1mg/kg and etomidate 0.3mg/kg.After tracheal intubateion, the patients were ventilated mechanically with inhalation of N_2O/O_2 1∶1 . Anesthesia was maintained by 1.5%-2% isoflurane inhalation in group I and target-controlled infusion of propofol with target concentration of 3-4μg/ml in group P. Vecuronium 40μg/kg was injected intermittently to maintain muscular relaxation. Venous blood 5ml was sampled in the morning during fast state in group N.For patients P and I venous blood 5ml was sampled before induction(T_0),1 h after induction(T_1),at 1h(T_2),3h(T_3),6h(T_4) and 24h(T_5) after craniotomy respectively and centrifuged for 10 min (2000r/min). 3 ml of serum was collected and stored in refrigerator (-80℃) for the measurements.Results NO,NOS and MDA were higher in groups P and I than those in group N at T_0(P<0.05).NO at T_4 and T_5,NOS and MDA at T_5 were lower than those at T_0 in group P(P<0.05).NO,NOS and MDA were lower in group P than those in group I at T_3,T_4 and T_5(P<0.05).Conclusion Compared with isoflurane anesthesia,target-controlled infusion of propofol can decrease peroxidation injury that exists perioperatively in the patients with cerebral tumor.