纳布啡对脑膜瘤切除术患者血流动力学的影响及脑保护作用

Effect of nalbuphine on hemodynamics and neuroprotection in patients undergoing resection of meningiomas

目的观察盐酸纳布啡对脑膜瘤手术患者血流动力学的影响及其脑保护作用。方法择期全身麻醉下行脑膜瘤切除术患者40例,随机分为2组各20例,实验组(N组,纳布啡组)和对照组(D组,生理盐水组)。记录麻醉诱导前(T1)、切开脑膜(T2)、手术结束(T3)、术后24h(T4)SBP、DBP和HR的变化,并分别测定各时间点血清NSE、S-100β、TNF?α和IL-6水平。结果与T1比较,D组SBP在T2时明显升高(P<0.05);2组DBP在T2差异有统计学意义(P<0.05)。与T1比较,D组HR在T2、T3均明显升高(P<0.05);2组HR在T2时差异有统计学意义(P<0.05)。与T1比较,2组NSE、S-100β、TNF?α和IL-6水平在T2-T4时均明显升高(P<0.05)。N组在T2~T4时NSE、S-100β、TNF?α和IL-6水平均明显低于D组(P<0.05)。结论麻醉诱导前静脉注射盐酸纳布啡0.2mg/kg对血流动力学影响轻微,可以抑制脑膜瘤术患者脑损伤标志物和炎症因子的升高,对脑膜瘤切除术患者有一定的脑保护作用。

Objective To explore the effects of nalbuphine on hemodynamics and its neuroprotective effects on patients undergoing resection of meningioma.Methods 40 patients underwent elective meningioma resection under general anesthesia and were randomly divided into 2 groups(n=20),the experimental group(N:nalbuphine group)and the control group(D:saline group).Levels of systolic BP(SBP)and diastolic BP(DBP)and heart rate(HR)values before anesthesia induction(T1),upon incising the meningeal(T2),at the end of surgery(T3)and 24 hours after the surgery(T4)were recorded.And the levels of Neuron Specific Enolase(NSE),S100βprotein(S100β),tumor necrosis factorα(TNF-α)and interleukin 6(IL-6)in serum at different time indices mentioned above were also determined.Results Compared with T1,the SBP of group D was significantly increased at T2(P<0.05).The DBP levels of both groups were significantly different at T2(P<0.05).Compared with T1,the HR of group D increased significantly at T2 and T3(P<0.05).The difference between the two groups was statistically significant(P<0.05).Compared with T1,the levels of NSE,S-100β,TNF-αand IL-6 were all significant(P<0.05).The NSE,S-100β,TNF-αand IL-6 levels of the group N at T2-T4 were significantly lower than those in group D(P<0.05).Conclusion Before inducing anesthesia,intravenous injection of nalbuphine hydrochloride of 0.2 mg/kg had slight influence on hemodynamics inhibited the increase of brain injury markers and inflammatory factors levels in patients with meningioma and hence exerted some neuroprotective effect on their brain.