丙泊酚与七氟烷对颅内动脉瘤介入栓塞术患者氧化应激反应及预后的影响

Effects of propofol and seven halothane on oxidative stress and prognosis in patients with intracranial aneurysms undergoing interventional embolization

目的观察丙泊酚与七氟烷对颅内动脉瘤介入栓塞术患者氧化应激反应及预后的影响。方法选取南阳市中心医院2017年1月至2018年5月全麻下颅内动脉瘤介入栓塞术患者146例,采用随机数字表法分为丙泊酚组(73例)和七氟烷组(73例),均采用右美托咪定、芬太尼和咪达唑仑进行诱导麻醉。术中,丙泊酚组给予持续靶控输注丙泊酚联合右美托咪定维持麻醉,七氟烷组给予持续靶控输注右美托咪定联合吸入七氟烷维持麻醉。比较两组停用麻醉药后睁眼时间、拔管时间及完全苏醒时间差异,检测两组麻醉前(T1)、复苏后12 h(T2)、24 h(T3)、48 h(T4)、72 h(T5)时血清过氧化物歧化酶(SOD)、过氧化氢酶(CAT)水平;采用格拉斯哥预后量表(GOS)于术后3个月时对两组患者预后情况进行评价。结果丙泊酚组睁眼时间、拔管时间、完全苏醒时间分别为(9.9±2.3)min、(13.4±2.8)min、(21.3±3.7)min,七氟烷组分别为(10.1±2.4)min、(12.9±2.7)min、(20.9±3.9)min,两组差异无统计学意义(P>0.05)。两组患者T 1时点血清SOD、CAT水平差异无统计学意义(P>0.05),T2~T5时点SOD、CAT水平均低于T1(P<0.05),其中丙泊酚组明显低于七氟烷组(P<0.05)。术后3个月,两组患者GOS预后分级比较,差异无统计学意义(P>0.05)。结论丙泊酚与七氟烷用于颅内动脉瘤介入栓塞术患者全麻维持,麻醉效果及预后相近,但七氟烷较丙泊酚更能减轻患者的氧化应激反应,对减轻脑组织损伤有潜在意义。

Objective To observe the effects of propofol and seven halothane on the oxidative stress response and prognosis of patients with intracranial aneurysms in order to provide reference for the selection of narcotic drugs.Methods A total of 146 patients with intracranial aneurysm underwent general anesthesia were enrolled as the study subjects.The cases were all from Nanyang Central Hospital.The study period was from January 2017 to May 2018.They were divided into propofol group(73 cases)and sevoflurane group(73 cases)by random number table method.All of them were induced by dexmedetomidine,fentanyl and midazolam.The difference intime of blinking,time of extubation and time of complete recovery after anesthesia were compared between the two groups.Serum levels of superoxide dismutase(SOD),catalase(CAT)of the two groups were assessedinthe pre-anesthesia(T1)and 12h(T2),24h(T3),48h(T4),and 72h(T5).The prognosis of the two groupswas evaluated using Glasgow Outcome Score(GOS)three months after operation.Results The propofol group had a blinking time of(9.9±2.3)min,a extubation time of(13.4±2.8)min,a complete recovery time of(21.3±3.7)min,and sevoflurane group had(10.1±2.4)min,(12.9±2.7)min,and(20.9±3.9)min,respectively;there was no significant difference between the groups(P>0.05).There was no significant difference in serum SOD,CAT activities between the two groups(P>0.05).The activities of SOD,CAT at T2~T5 were significantly lower than those atT1(P<0.05),in which the propofol group was significantly lower than the sevoflurane group(P<0.05).There was no significant difference in GOS score between the two groups three months afteroperation(P>0.05).Conclusion Propofol and sevoflurane are used to maintain general anesthesia in patients with intracranial aneurysm interventional embolization.The anesthesia effect and prognosis are similar,but sevoflurane can significantly reduce oxidative stress response in patients with propofol,indicating its potential significance in reducing brain tissue damage.