七氟烷和地氟烷对神经外科手术患者局部脑氧饱和度和Caspase-3蛋白水平影响的比较

Comparison of the Effects of Sevoflurane or Desflurane Anesthesia on the Regional Cerebral Oxygen Saturation and Serum Levels of Caspase-3 in Patients undergoing Neurosurgery

比较七氟烷和地氟烷吸入麻醉对神经外科手术患者局部脑氧饱和度(Cr SO_(2))和血清半胱氨酸蛋白酶-3(Caspase-3)蛋白表达水平的影响。本研究为前瞻性的随机对照临床试验。选择接受神经外科手术患者120例,年龄18~70岁,BMI:20~28,ASA分级Ⅰ~Ⅱ级,通过计算机随机数发生器将患者随机分为七氟烷组(S组,n=60)和地氟烷组(D组,n=60)。患者常规静脉顺序诱导,插入气管导管连接麻醉机使用间歇正压通气(IPPV)模式,调节空气∶氧气=1∶1吸入,总流量2 L/min,潮气量6~8 m L/kg,呼吸频率12次/min,I∶E为1∶2,PEEP 5 cm H_(2)O。S组使用2%~3%的七氟烷,D组使用7%~8%的地氟烷维持麻醉,根据患者的年龄在麻醉维持期间保持呼气末最低肺泡浓度(MAC)为0.8~1.2 MAC,手术结束前30 min停止吸入药物的使用。术中使脑电双频指数(BIS)维持在40~60之间,呼气末二氧化碳浓度(P_(ET)CO_(2))维持在35~45 mm Hg之间。在不同时间点:麻醉诱导前(T_(0))、呼气末MAC达到目标值后5 min(T_(1))、手术开始时(T_(2))、手术开始后30 min(T_(3))、呼气末MAC值为0后5 min(T_(4))和手术结束时(T_(5))使用近红外线光谱技术(NIRS)监测CrSO_(2),监测血流动力学指标(心率和MAP),脉搏氧饱和度(SpO_(2)),抽取桡动脉血测定血清中Caspase-3蛋白水平。与S组相比,D组患者在T_(4)和T_(5)时间点Caspase-3蛋白显著升高(P<0.05),在T_(0)~T_(3)时间点Caspase-3无明显差异(P>0.05)。与S组相比,D组患者在T_(5)时间点的CrSO_(2),心率和MAP均显著升高(P<0.05),在T_(0)~T_(4)时间点Cr SO_(2),心率和MAP无明显差异(P>0.05);SpO_(2)在T_(0)~T_(5)时间点均无明显差异(P>0.05)。神经外科手术患者使用地氟烷与使用七氟烷相比,术中血流动力学和Cr SO_(2)相似但Caspase-3蛋白升高。

To compare the effect of sevoflurane and desflurane on SrO_(2) and Serum levels of Caspase-3 of patients undergoing neurosurgery.In this clinical randomized double-blind controlled trial,120 patients with aged 18-70,BMI 20-28 and with the American Society Anesthesiology(ASA)Class I-II who underwent elective neurosurgery were randomly assigned by a computerised randomnumber generator list to one of two groups;sevoflurane administered group(Group S,n=60)and desflurane administered group(Group D,n=60).Anesthesia was induced with intravenous anesthetic,using intermittent positive pressure ventilation mode(IPPV).For anesthesia maintenance,the patients received 2%to 3%sevoflurane or 7%to 8%desfluranein 50%O_(2) and 50%air,patients were anesthetized with age-adjusted either sevoflurane or desflurane at 0.8 and 1.2 minimum alveolar concentration(MAC),with total flow 2 L/min,tidal volume 6~8 m L/kg,breathing frequency 12 times/min,I∶E=1∶2,PEEP 5 cm H_(2)O.Bispectral Index value were maintained between 40~60 and mechanical ventilation were adjusted to maintain end-tidal carbon dioxide between 35~45 mm Hg.Oxygen saturation(CrSO_(2),SpO_(2)),haemodynamic variables(MAP,heart rate)were monitored and recordedat six timepoints:before induction of anesthesia(T_(0)),5 minutes after the end-expiratory MAC reached the target value(T_(1)),at the start of the surgery(T_(2)),30 minutes after the surgery started(T_(3)),5 minutes after steady-state 0 MAC(T_(4))and at the end of the surgery(T_(5)).Blood samples were collected to determine serum Caspase-3 levels.Compared with group S,Caspase-3 of the patients in group D were significantly increased at T_(4) and T_(5)(P<0.05),and there were no significant differences at T_(0)~T_(3)(P>0.05).Compared with group S,Cr SO_(2),heart rate and MAP of the patients in group D were significantly increased at T_(5)(P<0.05),and there were no significant differences at T_(0)-T_(4)(P>0.05).SpO_(2) of all patients were no significant differences(P>0.05).In conclusion,desflurane and sevoflurane had similar effects in the preservation of hemodynamics and Cr SO_(2) in patients undergoing neurosurgery,while the Caspase-3 protein was increased when used of desflurane.