颅脑手术时异丙酚脑保护作用的观察

Observation of cerebral protective effect of propofol during neurosurgery

目的研究脑瘤手术期间静脉麻醉剂异丙酚体内的抗氧化特性及脑保护作用。方法择期行脑瘤手术患者２０例。随机分为观察组（异丙酚组，Ａ组ｎ＝１０）和对照组（异氟醚组，Ｂ组ｎ＝１０）。以电子自旋共振（ＥＳＲ）方法测定血浆ＯＦＲ及用化学方法测定ＬＰＯ含量。所有数据均行ｔ检验。结果两组手术前ＯＦＲ、ＬＰＯ显著高于正常值（Ｐ＜００１），开颅手术１２０分钟后两组ＯＦＲ、ＬＰＯ较术前有显著性升高（Ｐ＜００５），开颅手术２４０分后观察组ＯＦＲ、ＬＰＯ较术前及２小时前有显著性降低（Ｐ＜００１），而对照组则较２小时前有显著性升高（Ｐ＜００１）。两组比较有显著性差异（Ｐ＜００１）。结论脑瘤患者术前存在ＯＦＲ代谢紊乱，开颅手术可加重脑的再灌注损伤。本研究结果发现临床麻醉剂量的异丙酚对体内过量的ＯＦＲ有直接清除作用。开颅手术期间持续静脉点滴可减轻继发性脑损害而具有脑保护作用。异丙酚是颅脑手术麻醉、ＮＩＣＵ镇静的理想药物，值得推广应用。

Objective To study the antioxize properties of anesthestic propofol in vivo and it's cerebral protective effect during brian tumor resection. Methods 20 patients scheduled to undergo brain tumor resection were randomized to receive propofol (group A n=10) and isofluran (group B n=10) as control. Using electron spin resonace (ESR) spectroscopy method to measure plasma oxygen free radicals (OFR) and thiobitirc method to measure the plasma lipid peroxide (LPO). All datas were statistied by t tset. Results This experiment demonstrate that the OFR,LPO level were significantly higher in all patients than normal values before operation ( P <0 05). In both groups the OFR,LPO were significantly increased after 120 min of neurosurgery than that of before operation ( P <0 01). In gorup A, the two indexes reduced markadly 240 min after neurosurgery than that of before operation ( P <0 01). But in proup B were increased than that of two hours before ( P <0 01). There is sigificantly division between the groups ( P <0 01). Conclusion There is OFR metabolism disorder in patients with brain tumor before operation. Surgical procedures on the brain may induce secondary cerebral ischemia causing neurologic injury. Therapeutic dosese of propofol may play a role in brain protection and act as an OFR scavenger in vivo. Using propofol intravenous infusion drip during neurosurgical can prevent and abate the secondary cerebral injury. [