全麻状态下颅内动脉瘤夹闭术患者脑脊液中促红细胞生成素的变化

Changes of erythropoietin in cerebrospinal fluid of patients undergoing clipping of intracranial aneurysm

目的观察颅内动脉瘤夹闭术患者围术期全身麻醉后不同时间点的促红细胞生成素(EPO)的变化规律。方法随机选择ASAⅠ-Ⅲ级颅内动脉瘤夹闭术患者30例,Hunt-Hess分级Ⅰ-Ⅲ级,静吸复合全身麻醉,腰穿取不同时间点(麻醉诱导后、动脉瘤夹闭后即刻,术后2,4和24h)采集脑脊液,用酶联免疫吸附法检测脑脊液的EPO浓度。结果30例患者2例术后24h死亡,他们的EPO值均高于同期研究者数倍,余28例不同时间点EPO值由高到低依次为:术后2h>动脉瘤夹闭后即刻>术后4h>术后24h>麻醉诱导后,麻醉诱导后和各不同时间点间比较均有统计学差异。结论颅内动脉瘤夹闭术患者EPO的升高与术中机体受到伤害性刺激的损伤程度相一致,EPO应激性升高可能起脑保护作用,但体内的EPO并不能逆转损伤的进程。

Objective To investigate the changes of erythropoietin （EPO） in cerebrospinal fluid in patients undergoing clipping of intracranial aneurysm. Methods Thirty ASA Ⅰ-Ⅲ patients undergoing clipping of intracranial aneurysm were anesthetized. After tra- cheal intubation,lumbar puncture was performed in patients. The levels of EPO in cerebrospinal fluids were determined after by enzyme linked immunosorbent assay（ELISA） intubation, at the time of clipping aneurysm, at hour 2, 4,24 after surgery, respectively. Results Of 30 patients ,two patients died after surgery,with higher EPO than that of the others. The EPO levels decreased at hour 2 after surgery, clipping aneurysm, at hour 4 after surgery, at hour 24 after surgery, after tracheal intubation in turns. Compared with that after tracheal intubation ,EPO level showed a significant difference at the other time points. Conclusion The EPO level is coincident with the degree of surgery injury, and the increase of EPO may be favorable to neuroprotection. However, endogenous EPO could not reverse the development of the injury.