重型颅脑损伤患者血浆NO、ET水平变化及异丙酚对其影响

EFFECTS OF PROPOFOL ON CONTENTS OF NITRIC OXIDE AND ENDOTHELIN IN PATIENTS WITH SEVERE BRAIN TRAUMA

目的 :探讨重型颅脑损伤患者开颅手术麻醉期间血浆一氧化氮 (NO) ,内皮素 (ET)含量、一氧化氮合成酶(NOS)活性变化及静脉麻醉剂异丙酚 (PRO)对其影响。方法 :重型颅脑损伤患者 4 0例。根据麻醉方法不同随机分为观察组 (PRO组 )和对照组 (γ -OH组 )。观察自麻醉诱导前至开颅手术去骨瓣后 1,3,6 ,12 ,2 4h(用T0 ～T5表示 )诸指标水平变化。并以 4 0例健康者作为术前对照。结果 :术前患者血中NO ,NOS ,ET均高于正常对照组 ,其中NOS ,ET显著增高。随开颅手术时间的延长 ,γ -OH组NOS(T3 )NO(T5)ET(T1～T5)呈显著性升高。PRO组NO ,NOS自始至终呈降低趋势。NOS(T1) ,NO(T2 ) ,ET(T2 )时达到正常水平。结论 :重型颅脑损伤患者术前存在NO ,ET间含量平衡 ,临床麻醉剂量的PRO具有NOS、ET抑制剂特性。

Objective:To investigate the effects of propofol (pro) on the plasma contents of nitric oxide(NO), nitric oxide synthase activity(NOS) and endothelin (ET) in patients with severe brain trauma during neurosurgery.Methods:Forty patients with severe cerebral injury (ACI) were divided randomly into propofol group and γ-OH group as the control. Plasma samples were drawn before anesthesia to 1,3,6,12,24 hours (T 0～T 5).Results:NOS activity, ET were significantly increased before operation in patients compared with normal value.Compared with control proup, NOS activity (T 2～T 5) and NO (T 3～T 5) of propofol group were significantly decreased compared with T 0. Meanwhile ET(T 2) were significantly decreased compared with T 0.Conclusion:There are NO,ET metabolism disorder in patients with severe brain trauma before operation. Therapeutic dose of propofol treated may significantly inhibite NOS activity and act as an antagonistic effect to ET in vivo,and possess cerebral protective effect in many ways.