不同麻醉药物对颅内动脉瘤栓塞术后患者神经功能恢复影响的比较

Effects of different anesthetics on recovery of neurological function after intracranial aneurysm embolization

目的比较不同麻醉药物对颅内动脉瘤栓塞术后患者神经功能恢复的影响。方法动脉瘤性蛛网膜下腔出血拟全麻下行动脉瘤栓塞术患者100例。年龄〉18岁，BMI 18.5-24.0 kg/m2，ASA分级Ⅱ或Ⅲ级，WFNS分级Ⅰ-Ⅳ级，蛛网膜下腔出血厚度〉4 cm，性别不限。采用随机数字表法将其分为2组（n＝50）：丙泊酚组（P组）和七氟醚组（S组）。麻醉诱导后P组静脉输注丙泊酚100-300 μg·kg^－1·min^－1，S组维持呼气末七氟醚浓度1.4%-3.5%。于麻醉诱导前即刻（T0）、诱导结束后即刻（T1）、动脉瘤栓塞成功后即刻（T2）、术后1、2、3和5 d（T3-6）时分别采集中心静脉血，采用ELISA法检测血浆神经元特异性烯醇化酶（NSE）和S100β蛋白的浓度。记录患者术后脑血管痉挛（CVS）和迟发性缺血性神经功能障碍（DIND）的发生情况。术后随访，记录患者术后6个月格拉斯哥预后评分（GOS评分）和新发脑梗塞的发生情况。结果2组患者各时点血浆NSE和S100β蛋白浓度，术后CVS和DIND发生率、术后6个月GOS评分及新发脑梗塞发生率差异无统计学意义（P〉0.05）。结论丙泊酚和七氟醚对颅内动脉瘤栓塞术后患者神经功能恢复的影响无差异。

Objective To compare the effects of different anesthetics on the recovery of neurological function after intracranial aneurysm embolization.Methods One hundred patients of both sexes with aneurysmal subarachnoid hemorrhage, aged more than 18 yr, with body mass index of 18.5-24.0 kg/m2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ and WFNS grade Ⅰ-Ⅳ, with the thickness of subarachnoid hemorrhage more than 4 cm, were divided into 2 groups （n=50 each） using a random number table： propofol group （group P） and sevoflurane group （group S）. After anesthesia induction, group P received intravenous infusion of propofol 100-300 μg·kg-1·min-1, while the end-tidal sevoflurane concentration was maintained at 1.4%-3.5% in group S. Immediately before induction （T0）, immediately after the end of induction （T1）, immediately after successful embolization of aneurysm （T2） and at 1, 2, 3 and 5 days after surgery （T3-6）, central venous blood samples were collected for determination of plasma neuron-specific enolase and S100β protein concentrations by enzyme-linked immunosorbent assay.The development of postoperative cerebral vasospasm and delayed ischemic neurological deficit was recorded.The patients were followed up, and the Glasgow outcome score and occurrence of newly developed cerebral infarction were recorded within 6 months after surgery.Results There was no significant difference in the concentrations of plasma neuron-specific enolase and S100β protein at each time point, incidence of postoperative cerebral vasospasm and delayed ischemic neurological deficit, or Glasgow outcome score and incidence of newly developed cerebral infarction within 6 months after surgery between two groups （P〉0.05）.Conclusion Propofol and sevoflurane exert no effect on the recovery of neurological function after intracranial aneurysm embolization.