羟乙基淀粉对癫痫患者脑组织含水量、颅内压以及脑组织水通道蛋白-4和N-甲基-D-天冬氨酸受体1表达的影响

The Influence of Hydroxyethyl Starch on Brain Tissue Water Content,Intracranial Pressure,Expression of Aquaporin-4 and N-methyl-D-aspartate Receptor 1 of Epilepsy Patients

目的探讨高渗氯化钠羟乙基淀粉对癫痫手术患者脑组织含水量、颅内压以及脑组织水通道蛋白4和N-甲基-D-天冬氨酸受体1表达的影响。方法选择2013年1月至2014年4月四川省肿瘤医院确诊癫痫拟行癫痫灶切除术的患者48例,依据随机数字表法分为4组:A组(6%中分子羟乙基淀粉,晶胶比0∶1)、B组(6%中分子右旋糖酐,晶胶比0∶1)、C组(6%中分子羟乙基淀粉,晶胶比1∶1)、D组(6%中分子右旋糖酐,晶胶比1∶1),各12例。分析4组患者术中颅内压及切除脑组织中的脑含水量、水通道蛋白4和N-甲基-D-天冬氨酸受体1的表达情况。结果 4组间颅内压、脑组织含水量、水通道蛋白4吸光度值、N-甲基-D-天冬氨酸受体1的吸光度值比较差异有统计学意义(P<0.05),其中B组各指标均高于其他3组,其次是A组高于C、D组,且D组高于C组。结论癫痫灶切除术的围术期液体应用中,6%中分子羟乙基淀粉与晶胶比1∶1的配合使用的补液最具有临床应用价值。

Objective To investigate the influence of hypertonic sodium chloride hydroxyethyl starch on brain tissue water content,intracranial pressure,expression of aquaporin-4 and N-methyl-D-aspartate receptor1 of epilepsy patients undergoing brain surgery. Methods A total of 48 epilepsy patients undergoing epileptic foci resection in Sichuan Provincial Tumor Hospital from Jan. 2013 to Apr. 2014 were included in the study,in were randomly divided into four groups according to random-number table method to receive different colloids during operation（ 6% hydroxyethyl starch molecules,6% dextran molecules） and crystal-glue ratio（ 0∶1,1∶1） ： group A（ 6% medium molecule hydroxyethyl starch,the crystal glue ratio 0 ∶ 1）,group B（ 6% medium molecule dextran,crystal glue ratio 0∶1）,group C（ 6% medium molecule hydroxyethyl starch,crystal glue ratio 1 ∶ 1）,group D（ 6% medium molecule dextran,crystal glue ratio 1 ∶ 1）. The intracranial pressure,cerebral water content,expression of aquaporin-4 and N-methyl-D-aspartate receptor-1 in brain tissue of the four groups were compared. Results The difference on each index was statistically significant among the four groups（ intracranial pressure,brain water content,aquaporin 4 absorbance value,N-methyl-Daspartate receptor-1 absorbance value）（ P〈0. 05）,among which the indexes of group B were higher than the other three groups,followed by the group A,and then group D. Conclusion In perioperative fluid application during epileptic resection,the liquid which contains 6% medium molecule hydroxyethyl starch with the crystal glue ratio of 1∶1 has the highest clinical applicative value.