七氟醚对行颅内动脉瘤夹闭术患者脑缺血-再灌注损伤的保护作用

Protective Effect of Sevoflurane on Cerebral Ischemia-reperfusion Injury in Patients Undergoing Intracranial Aneurysm Clipping

目的探究七氟醚应用于颅内动脉瘤夹闭术中的载瘤动脉阻断前后对脑缺血-再灌注损伤的影响及可能机制。方法选择行颅内动脉瘤夹闭术的患者60 例,随机分为七氟醚组和对照组。对照组采用全凭静脉麻醉,七氟醚组在静脉麻醉的基础上,于载瘤动脉阻断前及载瘤动脉再通后各吸入2%七氟醚30 min。记录载瘤动脉阻断前(T1)、载瘤动脉阻断后5 min(T3)、载瘤动脉再通后5 min(T5)2 组患者的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR),并在麻醉诱导前(T0)、载瘤动脉阻断时(T2)、载瘤动脉再通时(T4)、再通后2 h(T6)、再通后6 h(T7)、再通后24 h(T8)抽取患者的颈内静脉血,检测星形胶质细胞S100 蛋白的β亚型(beta isoform of S100 protein in astrocytes,S100β蛋白)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、丙二醛(malondialdehyde,MDA)水平。结果 2 组间MAP、HR 的差异无统计学意义。载瘤动脉阻断后2 组患者S100β蛋白、TNF-α和MDA 浓度较术前均有不同程度升高(P<0.05),但七氟醚组在T4 和T6~T8 时的浓度低于对照组(P<0.05)。结论七氟醚对脑缺血-再灌注损伤具有一定保护作用,其机制与抑制过度炎症反应和氧化应激反应有关。

OBJECTIVE To explore the effect and its potential mechanism of sevoflurane on cerebral ischemia-reperfusion injury before and after parent artery occlusion during clipping of intracranial aneurysm.METHODS Sixty patients undergoing clipping of intracranial aneurysm were selected and randomly divided into sevoflurane group and control group.Control group adopted venous anesthesia alone,while sevoflurane group had inhaled 2% sevoflurane for 30 min before parent artery occlusion and after patency of parent artery based on venous anesthesia,respectively.The mean arterial pressure(MAP) and heart rate(HR) in both groups before parent artery occlusion(T1),5 min after parent artery occlusion(T3),and 5 min after patency of parent artery(T5) were recorded.Moreover,the jugular venous blood was collected from patients in both groups before anesthesia induction(T0),at the time of parent artery occlusion(T2),at the time of patency of parent artery(T4),2 h after patency(T6),6 h after patency(T7),and 24 h after patency(T8) to detect the beta isoform of S100 protein in astrocytes(S100β protein),tumor necrosis factor-α(TNF-α) and malondialdehyde(MDA) levels.RESULTS Differences of MAP and HR between two groups were not statistically.After parent artery occlusion,the S100β protein,TNF-α and MDA concentrations in both groups were elevated to various degrees compared with those before surgery(P<0.05);while those concentrations in sevoflurane group were lower than those in control group at T4 and T6-T8(P<0.05).CONCLUSION Sevoflurane shows certain protection on cerebral ischemia-reperfusion injury,and its mechanism may be related to the suppression of excessive inflammatory response and oxidative stress response.