CAJ | 학술논문

目的探讨异丙酚后处理对颅内动脉瘤夹闭术患者脑缺血再灌注时脑组织抗氧化作用的影响.方法择期拟行颅内动脉瘤夹闭术患者30例,年龄26～64岁,体重53～73 ks,ASA Ⅰ或Ⅱ级,随机分为2组(n=15):对照组(C组)和异丙酚后处理组(P组).C组吸入0.5%～2.0%七氟烷,P组在开放载瘤动脉前吸入0.5%～2.0%七氟烷,开放载瘤动脉即刻靶控输注异丙酚至术毕,血浆靶浓度设为1.2μg/ml,同时下调七氟烷吸人浓度,维持BIS 40～60.于麻醉诱导前即刻(T_0)、阻断载瘤动脉即刻(T_1)、开放载瘤动脉即刻(T_2)、开放载瘤动脉后30min(T_3)、1 h(T_4)及术毕(T_5)时测定脑脊液压力,于T_0、T_3、T_5及术后24 h(T_6)时测定脑脊液F_2-异前列腺素(F_2-IsoPs)、α-生育酚(α-T)及γ-生育酚(γ-T)的浓度.结果与T_0时比较,L_(4,5)时C组脑脊液压力降低,T_(3～5)时P组脑脊液压力降低,T_(3,5,6)时两组脑脊液α-T及γ-T的浓度降低,F_2-IsoPs浓度升高(P＜0.05);与C组比较,P组T_(3,4)时脑脊液压力降低,T_(3,5,6)时γ-T浓度升高,F_2-IsoPs浓度降低(P＜0.05).结论异丙酚后处理可增强颅内动脉瘤夹闭术患者脑缺血再灌注时脑组织的抗氧化作用.
목적 탐토이병분후처리대로내동맥류협폐술환자뇌결혈재관주시뇌조직항양화작용적영향.방법 택기의행로내동맥류협폐술환자30례,년령26～64세,체중53～73 ks,ASA Ⅰ혹Ⅱ급,수궤분위2조(n=15):대조조(C조)화이병분후처리조(P조).C조흡입0.5%～2.0%칠불완,P조재개방재류동맥전흡입0.5%～2.0%칠불완,개방재류동맥즉각파공수주이병분지술필,혈장파농도설위1.2μg/ml,동시하조칠불완흡인농도,유지BIS 40～60.우마취유도전즉각(T_0)、조단재류동맥즉각(T_1)、개방재류동맥즉각(T_2)、개방재류동맥후30min(T_3)、1 h(T_4)급술필(T_5)시측정뇌척액압력,우T_0、T_3、T_5급술후24 h(T_6)시측정뇌척액F_2-이전렬선소(F_2-IsoPs)、α-생육분(α-T)급γ-생육분(γ-T)적농도.결과 여T_0시비교,L_(4,5)시C조뇌척액압력강저,T_(3～5)시P조뇌척액압력강저,T_(3,5,6)시량조뇌척액α-T급γ-T적농도강저,F_2-IsoPs농도승고(P＜0.05);여C조비교,P조T_(3,4)시뇌척액압력강저,T_(3,5,6)시γ-T농도승고,F_2-IsoPs농도강저(P＜0.05).결론 이병분후처리가증강로내동맥류협폐술환자뇌결혈재관주시뇌조직적항양화작용.
Objective To investigate the effect of TCI of propofol(Cp 1.2 μg/ml)starting from the end of temporary occlusion of the cerebral artery and maintained until the end of operation on antioxidative effects of brain during cerebral ischemia-reperfusion injury in patients undergoing elective clipping of intracranial aneurysm.Methods Thirty ASA Ⅰ or Ⅱ patients,aged 26-64 yr,weighted 53-73 kg,undergoing elective intracranial aneurysm clipping were randomly divided into 2 groups(n = 15 each): control group(group C)and propofol postconditioning(group P).A catheter was placed in the subarachnoid space at L_(3,4) interspace for CSF pressure monitoring and collection of CSF samples.Radial artery was cannulated for MAP monitoring.ECG,HR,MAP,SpO_2,P_(ET)CO_2 and BIS were continuously monitored.Anesthesia was induced with midazolam,propofol,fentanyl and rocuronium and maintained with 0.5%-2.0% sevoflurane,iv infusion of fentanyl and intermittent iv boluses of vecuronium.In group P TCI of propofol(Cp 1.2 μg/ml)was started from the end of temporary occlusion of cerebral artery and maintained until the end of operation.Meanwhile the sevoflurane concentration was decreased and BIS was maintained at 40-60.CSF pressure was measured before induction of anesthesia(T_0),immediately after occlusion of cerebral artery(T_1),immediately(T_2)and at 30 min(T_3)and 1 h(T_4)after removal of cerebral artery occlusion and at the end of operation(T_5).CSF concentrations of F_2-isoprostances(F_2-IsoPs)(by ELISA)and α-and γ-tocopherol(α-T,γ-T)were measured at T_0,T_3,T_5 and 24 h after operation(T_6).Results CSF pressure was significantly lower at T_3 and T_4 in group P than in group C.The CSF concentrations of α-T andγ-T were significantly decreased at T_3,T_5 and T_6 as compared with the baseline at T_0 in both groups.There was no significant difference in α-T concentration between the two groups;while the γ-T concentration in CSF was significantly higher at T_3,T_5 and T_6 in group P than in group C.The CSF concentrations of F_2-IsoPs were significantly increased at T_3,T_5 and T_6 as compared with the baseline at T_0 in both groups and were significantly lower in group P than in group C.Conclusion TCI of propofol with Cp at 1.2 μg/ml starting from the end of temporary cerebral artery occlusion and maintained until the end of operation can enhance the antioxidative effects of brain in patients undergoing clipping of intracranial aneurysm.