不同麻醉药预处理对颅脑手术患者的脑保护作用

Effect of different anesthetics pretreatment on brain neuroprotection in patients undergoing neurosurgery

目的：研究不同药物的麻醉预处理对颅脑手术患者脑功能变化的影响。方法选择颅脑神经顺应性正常行颅脑手术的患者75例。随机分为五组，每组15例：A组，对照组；B组，异丙酚预处理组；C组，异氟醚预处理组；D组，利多卡因预处理组；E组，异丙酚＋利多卡因预处理组。气管插管后至开颅钻孔时，B、C、D、E组实施不同的麻醉预处理。监测并检验患者诱导前（T0）、手术结束时（T1）静脉血乳酸（LAD）、丙二醛（MDA）、超氧化物歧化酶（SOD）、神经元特异性烯醇化酶（NSE）含量；T0时和术后24 h（T2）、48 h（T3）、3 d（T4）时IL-1、TNF-α、乳酸脱氢酶（LDH）、肌磷酸激酶（CPK）含量。结果与T0时比较，各组T1时NSE含量均较高（P＜0.05）；SOD、MDA值均有不同程度的升高，其中E组SOD值和A组MDA升高具有统计学差异（P＜0.05）；LAD无统计学差异。与T0时比较，T2～T4时各组IL-1、TNF-α、LDH、CPK值均有不同程度的升高（P＜0.05）；与A组比较， E组T2～T4时IL-1、TNF-α、LDH、CPK均有统计学差异（P＜0.05）；与E组比较，B、C、D组T4时IL-1、TNF-α、LDH、CPK值升高幅度具有统计学差异（P＜0.05）。结论应用异丙酚、异氟醚、利多卡因行麻醉预处理，对颅脑手术患者均有一定的脑保护作用。在抑制炎性反应及预防缺血再灌注损伤方面，异丙酚＋利多卡因联合麻醉预处理，脑保护效应更为显著。

ObjectiveTo evaluate effect of anesthetic pretreatment with different drugs on brain function changes in patients undergoing neurosurgery.Methods Seventy-five （40 males and 35 females） ASAⅠorⅡ neurosurgical patients, whose cranial nerve compliance was normal, aged 18-61 yr undergoing elective surgery under general anesthesia were randomly divided into 5 groups （n=15 each）： group A （control group）;group B, pretreated with TCL of propofol（Cp 5μg/ml）;group C, pretreated with inhaled isoflurane （MAC value of 2.0）;group D, pretreated with TCL of lidocaine（Cp 5μg/ml）;group E, pretreated with TCL of propofol （Cp 5μg/ml） and lidocaine（Cp 5μg/ml）. Anesthesia was induced with etomidate （0.2 mg/kg）, remifentanil （2μg/kg）, midazolam（5 mg） and vecuronium bromide（0.12 mg/kg）. After tracheal intubation to drilling craniotomy, the patients pretreated with different drugs in group B, C, D and E. Blood lactic acid （LAD）, superoxide dismutase（SOD）, malondialdehyde （MDA） and neuron-specific enolase （NSE） content were measured before the pretreatment （T0, baseline）, at the end of surgery （T1）. The blood samples were taken at T0 and 24, 48 h（T2-3）, at 3 d （T4） after operation for measurement of white blood cells Interleukin-1 （IL-1）, tumor necrosis factor （TNF-α）, lactate dehydrogenase （LDH）, muscle phosphokinase （CPK）.ResultsCompared with T0, NSE content were higher in group T1（P〈0.05）. SOD, MDA increased in varying degrees, of which E group SOD and A group MDA increased with significant difference（P〈0.05）. There were no significant differences in LAD. Compared with T0, T2-T4 IL-1, TNF-α, LDH groups, CPK increased in varying degrees（P〈0.05）. Compared with group A, group E T2-T4 IL-1, TNF-α, LDH, CPK were statistically different（P〈0.05）. Compared with group E, B, C, D group, T4 IL-1, TNF-α, LDH, CPK values increased with significant difference（P〈0.05）.ConclusionThe pretreatment with all of propofol, isoflurane and lidocaine in patients undergoing neurosurgery has some protection for their cranial nerve cells. Joint pretreatment with propofol and lidocaine are more favorable for restrainning the inflammatory response and preventive against ischemia-reperfusion on the brain protection effect of neurosurgery.