盐酸纳洛酮对颅脑手术病人血浆和脑脊液β-内啡肽的影响

Effect of hydrochloride naloxone on β-endorphin in plasma and cerebrospinal fluid during craniotomy

目的 :通过观察在颅脑手术中盐酸纳洛酮对血浆和脑脊液中 β-内啡肽 ( β- EP)的影响 ,探讨盐酸纳洛酮的脑保护作用。方法 :32例择期颅脑手术病人 ASA ～ 级 ,随机分为纳洛酮组( 组 )和对照组 ( 组 )。采用放射免疫分析法检测血浆及脑脊液中β- EP的含量。结果 :纳洛酮组在给药后 1 h( T2 期 )、给药后 2 h( T3 期 )和给药后 3h( T4期 )血浆β- EP含量分别为 ( 1 87.76±81 .37)、( 1 0 9.5 6± 45 .92 )和 ( 69.37± 2 1 .66) ng·L-1,脑脊液中含量分别为 ( 2 1 69.61± 41 6.37)、( 1 369.85± 433.5 5 )和 ( 987.62± 2 78.1 9) ng· L-1,均较给药前 ( T1期 )即开始切硬膜时低( P<0 .0 5 ) ,纳洛酮组血浆和脑脊液中的β- EP均低于对照组同期值 ( P<0 .0 5 )。结论 :颅脑手术围术期应用纳洛酮可以使脑脊液和血浆中β- EP含量降低 ,从而说明应用纳洛酮可以减轻脑水肿和损伤 ,保护脑细胞。

Objective:To observe the effect of hydrochloride naloxone on β endorphin in plasma and cerebrospinal fluid (CSF),β EP, during craniotomy. Methods:Thirty two patients (ASA 1~2) receiving the neurosurgery were divided randomly into hydrochloride naloxone group (Ⅰ) and control group (Ⅱ). Measure β EP in plasam and CSF using the radio immanoassay (RIA) while MAP, Tp and HR were monitored. Results:After applying hydrochloride naloxone 1 hour (T 2) , 2 hours (T 3) and 3 hours (T 4) β EP was (ng·L -1 ), plasam:187 76±81 37, 109 56 ±45 92, 74 76±38 90,respectively, and 2169 61±416 37,1369 85±433 55, 987 62±278 19 in CSF, respectivel. In comparission with T 1 in both specimens level of β EP was signifcantly decreased than those of control group ( P <0 05). Conclusion:application of hydrochloride naloxone could decrease β EP in plasam and CSF and protect cerebral cells during craniotomy.