国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2012年
9期
587-592
,共6页
目的 观测川芎嗪(tetramethy/phrazine,TMP)对幕上肿瘤切除术患者围术期血清S100β蛋白(S100β protein,S100β)、神经元特异性烯醇化酶(neuron specific enolase,NSE)、超氧化物歧化酶(superoxdie dismutase,SOD)和丙二醇( malondialdehyde,MDA)含量及脑氧供需平衡与能量代谢的影响.方法 择期行幕上肿瘤切除术患者24例,美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级,采用随机数字表法分为对照组(A组)和TMP组(B组),每组12例.采用丙泊酚静脉复合全麻,切开硬脑膜中20 min内,A组输入0.9％生理盐水250 ml;B组输入含80 mg盐酸TMP的等量生理盐水.分别于全麻诱导前(T1)、气管插管后(T2)、切开硬脑膜即刻(T3)、切硬脑膜后1 h(T4)、缝硬脑膜时(T5)、术后24 h(T6)同步采集颈内静脉球部血和足背动脉血检测血气、乳酸、血糖浓度、血氧饱和度及氧分压,计算血氧含量、血氧含量差及脑氧摄取率、葡萄糖摄取率、脑乳酸生成率、脑乳酸氧指数;同时留置颈内静脉球部血检测血清S100β、NSE及SOD、MDA含量;并记录各时点平均动脉压、心率、红细胞压积与血红蛋白.结果 ①脑氧摄取率:与T1[(36±5)％、(35±5)％]比较,两组均在T2[(24±6)％、(25±5)％]下降,而在T6[(42±5)％、(41±6)％]上升(P＜0.05).组间各时点无统计学差异(P＞0.05).②颈内静脉血氧含量差:与T1[(6.0±1.0)vo1％、(6.4±1.1 )vol％]比较,两组均在T2[ (4.2±1.1)vol％、(4.5±1.0)vol％]下降,而B组在T5 (5.3±0.8)vol％、T6(5.4±0.8)vol％也较T1下降(P＜0.05);组间各时点无统计学差异(P＞0.05).③脑乳酸生成率:两组于T2[(-0.033±0.008)％、(-0.026±0.007)％]、T3[(-0.031±0.006)％、(-0.028±0.005)％]、T4[(-0.025±0.005)％、(-0.026±0.006)％]、T5[(-0.022±0.008)％、(-0.027±0.008)％]与T6 [(0.021±0.005)％、(-0.024±0.003)％]均低于T1[ (0.073±0.009)％、(0.067±0.010)％];组间各时点间无统计学差异(P＞0.05).④脑乳酸氧指数:两组于T2[(-0.021 3±0.009 1)、(-0.014 1±0.004 1)]、T3[(-0.013 2±0.004 2)、(-0.012 3±0.003 3)]、T4[(-0.011 4±0.002 9)、(-0.012 4±0.004 3)]、T5[(-0.011 2±0.003 4)、(-0.014 3±0.005 1)]与T6[(-0.010 3±0.003 0)、(-0.011 0±0.002 0)]均低于T1 [(0.021 6±0.007 3)、(0.022 5±0.007 0)],组间各时点间无统计学差异(P＞0.05).⑤SOD:A组于T3(77±13)、T4(69±9)、T5(65±12)、T6(75±14) U/ml较T1(99±9) U/ml下降(P＜0.05),B组于T3(84±12)、T4(79±12)、T5(76±12) U/ml较T1(98±10) U/ml下降(P＜0.05),但与A组相同时点比较,下降程度较小(P＜0.05),且于T6(90±17) U/ml恢复至术前水平(P＜0.05).⑥MDA:A组各时点间无统计学差异(P＞0.05);B组于T4[(5.6±0.7)vs(6.9±1.3)]、T5[(5.6±0.5)vs(6.7±1.5)]、T6[ (5.7±0.5)vs(6.5±0.9)]μmol/L均低于A组相同时点(P＜0.05).⑦B组S100β于T4[(1.60±0.43)vs(1.81±0.10)]、T5[(1.60±0.57)vs(1.86±0.08)]、T6[(1.59±0.05)vs(1.89±0.07)] μg/L及NSE于T4[(17.4±1.1 )vs (20.3±1.1)]、T5[(16.7±1.2)vs(21.3±0.9)]、T6[ (15.9±1.2)vs (22.2±0.7)]μg/L均低于A组相同时点(P＜0.05).结论 TMP能提高幕上肿瘤切除术围术期患者血清SOD活性,降低MDA含量及血清S100β、NSE浓度,但不能纠正能量代谢与脑氧供需失衡.
目的 觀測川芎嗪(tetramethy/phrazine,TMP)對幕上腫瘤切除術患者圍術期血清S100β蛋白(S100β protein,S100β)、神經元特異性烯醇化酶(neuron specific enolase,NSE)、超氧化物歧化酶(superoxdie dismutase,SOD)和丙二醇( malondialdehyde,MDA)含量及腦氧供需平衡與能量代謝的影響.方法 擇期行幕上腫瘤切除術患者24例,美國痳醉醫師協會(ASA)分級Ⅰ～Ⅱ級,採用隨機數字錶法分為對照組(A組)和TMP組(B組),每組12例.採用丙泊酚靜脈複閤全痳,切開硬腦膜中20 min內,A組輸入0.9％生理鹽水250 ml;B組輸入含80 mg鹽痠TMP的等量生理鹽水.分彆于全痳誘導前(T1)、氣管插管後(T2)、切開硬腦膜即刻(T3)、切硬腦膜後1 h(T4)、縫硬腦膜時(T5)、術後24 h(T6)同步採集頸內靜脈毬部血和足揹動脈血檢測血氣、乳痠、血糖濃度、血氧飽和度及氧分壓,計算血氧含量、血氧含量差及腦氧攝取率、葡萄糖攝取率、腦乳痠生成率、腦乳痠氧指數;同時留置頸內靜脈毬部血檢測血清S100β、NSE及SOD、MDA含量;併記錄各時點平均動脈壓、心率、紅細胞壓積與血紅蛋白.結果 ①腦氧攝取率:與T1[(36±5)％、(35±5)％]比較,兩組均在T2[(24±6)％、(25±5)％]下降,而在T6[(42±5)％、(41±6)％]上升(P＜0.05).組間各時點無統計學差異(P＞0.05).②頸內靜脈血氧含量差:與T1[(6.0±1.0)vo1％、(6.4±1.1 )vol％]比較,兩組均在T2[ (4.2±1.1)vol％、(4.5±1.0)vol％]下降,而B組在T5 (5.3±0.8)vol％、T6(5.4±0.8)vol％也較T1下降(P＜0.05);組間各時點無統計學差異(P＞0.05).③腦乳痠生成率:兩組于T2[(-0.033±0.008)％、(-0.026±0.007)％]、T3[(-0.031±0.006)％、(-0.028±0.005)％]、T4[(-0.025±0.005)％、(-0.026±0.006)％]、T5[(-0.022±0.008)％、(-0.027±0.008)％]與T6 [(0.021±0.005)％、(-0.024±0.003)％]均低于T1[ (0.073±0.009)％、(0.067±0.010)％];組間各時點間無統計學差異(P＞0.05).④腦乳痠氧指數:兩組于T2[(-0.021 3±0.009 1)、(-0.014 1±0.004 1)]、T3[(-0.013 2±0.004 2)、(-0.012 3±0.003 3)]、T4[(-0.011 4±0.002 9)、(-0.012 4±0.004 3)]、T5[(-0.011 2±0.003 4)、(-0.014 3±0.005 1)]與T6[(-0.010 3±0.003 0)、(-0.011 0±0.002 0)]均低于T1 [(0.021 6±0.007 3)、(0.022 5±0.007 0)],組間各時點間無統計學差異(P＞0.05).⑤SOD:A組于T3(77±13)、T4(69±9)、T5(65±12)、T6(75±14) U/ml較T1(99±9) U/ml下降(P＜0.05),B組于T3(84±12)、T4(79±12)、T5(76±12) U/ml較T1(98±10) U/ml下降(P＜0.05),但與A組相同時點比較,下降程度較小(P＜0.05),且于T6(90±17) U/ml恢複至術前水平(P＜0.05).⑥MDA:A組各時點間無統計學差異(P＞0.05);B組于T4[(5.6±0.7)vs(6.9±1.3)]、T5[(5.6±0.5)vs(6.7±1.5)]、T6[ (5.7±0.5)vs(6.5±0.9)]μmol/L均低于A組相同時點(P＜0.05).⑦B組S100β于T4[(1.60±0.43)vs(1.81±0.10)]、T5[(1.60±0.57)vs(1.86±0.08)]、T6[(1.59±0.05)vs(1.89±0.07)] μg/L及NSE于T4[(17.4±1.1 )vs (20.3±1.1)]、T5[(16.7±1.2)vs(21.3±0.9)]、T6[ (15.9±1.2)vs (22.2±0.7)]μg/L均低于A組相同時點(P＜0.05).結論 TMP能提高幕上腫瘤切除術圍術期患者血清SOD活性,降低MDA含量及血清S100β、NSE濃度,但不能糾正能量代謝與腦氧供需失衡.
목적 관측천궁진(tetramethy/phrazine,TMP)대막상종류절제술환자위술기혈청S100β단백(S100β protein,S100β)、신경원특이성희순화매(neuron specific enolase,NSE)、초양화물기화매(superoxdie dismutase,SOD)화병이순( malondialdehyde,MDA)함량급뇌양공수평형여능량대사적영향.방법 택기행막상종류절제술환자24례,미국마취의사협회(ASA)분급Ⅰ～Ⅱ급,채용수궤수자표법분위대조조(A조)화TMP조(B조),매조12례.채용병박분정맥복합전마,절개경뇌막중20 min내,A조수입0.9％생리염수250 ml;B조수입함80 mg염산TMP적등량생리염수.분별우전마유도전(T1)、기관삽관후(T2)、절개경뇌막즉각(T3)、절경뇌막후1 h(T4)、봉경뇌막시(T5)、술후24 h(T6)동보채집경내정맥구부혈화족배동맥혈검측혈기、유산、혈당농도、혈양포화도급양분압,계산혈양함량、혈양함량차급뇌양섭취솔、포도당섭취솔、뇌유산생성솔、뇌유산양지수;동시류치경내정맥구부혈검측혈청S100β、NSE급SOD、MDA함량;병기록각시점평균동맥압、심솔、홍세포압적여혈홍단백.결과 ①뇌양섭취솔:여T1[(36±5)％、(35±5)％]비교,량조균재T2[(24±6)％、(25±5)％]하강,이재T6[(42±5)％、(41±6)％]상승(P＜0.05).조간각시점무통계학차이(P＞0.05).②경내정맥혈양함량차:여T1[(6.0±1.0)vo1％、(6.4±1.1 )vol％]비교,량조균재T2[ (4.2±1.1)vol％、(4.5±1.0)vol％]하강,이B조재T5 (5.3±0.8)vol％、T6(5.4±0.8)vol％야교T1하강(P＜0.05);조간각시점무통계학차이(P＞0.05).③뇌유산생성솔:량조우T2[(-0.033±0.008)％、(-0.026±0.007)％]、T3[(-0.031±0.006)％、(-0.028±0.005)％]、T4[(-0.025±0.005)％、(-0.026±0.006)％]、T5[(-0.022±0.008)％、(-0.027±0.008)％]여T6 [(0.021±0.005)％、(-0.024±0.003)％]균저우T1[ (0.073±0.009)％、(0.067±0.010)％];조간각시점간무통계학차이(P＞0.05).④뇌유산양지수:량조우T2[(-0.021 3±0.009 1)、(-0.014 1±0.004 1)]、T3[(-0.013 2±0.004 2)、(-0.012 3±0.003 3)]、T4[(-0.011 4±0.002 9)、(-0.012 4±0.004 3)]、T5[(-0.011 2±0.003 4)、(-0.014 3±0.005 1)]여T6[(-0.010 3±0.003 0)、(-0.011 0±0.002 0)]균저우T1 [(0.021 6±0.007 3)、(0.022 5±0.007 0)],조간각시점간무통계학차이(P＞0.05).⑤SOD:A조우T3(77±13)、T4(69±9)、T5(65±12)、T6(75±14) U/ml교T1(99±9) U/ml하강(P＜0.05),B조우T3(84±12)、T4(79±12)、T5(76±12) U/ml교T1(98±10) U/ml하강(P＜0.05),단여A조상동시점비교,하강정도교소(P＜0.05),차우T6(90±17) U/ml회복지술전수평(P＜0.05).⑥MDA:A조각시점간무통계학차이(P＞0.05);B조우T4[(5.6±0.7)vs(6.9±1.3)]、T5[(5.6±0.5)vs(6.7±1.5)]、T6[ (5.7±0.5)vs(6.5±0.9)]μmol/L균저우A조상동시점(P＜0.05).⑦B조S100β우T4[(1.60±0.43)vs(1.81±0.10)]、T5[(1.60±0.57)vs(1.86±0.08)]、T6[(1.59±0.05)vs(1.89±0.07)] μg/L급NSE우T4[(17.4±1.1 )vs (20.3±1.1)]、T5[(16.7±1.2)vs(21.3±0.9)]、T6[ (15.9±1.2)vs (22.2±0.7)]μg/L균저우A조상동시점(P＜0.05).결론 TMP능제고막상종류절제술위술기환자혈청SOD활성,강저MDA함량급혈청S100β、NSE농도,단불능규정능량대사여뇌양공수실형.
Objective To evaluate the effects of intraoperative tetramethylpyrazine infusion on serum S100β protein (S100β),neuron-specific enolase (NSE),superoxdie dismutase (SOD) and malondialdehyde (MDA) content and cerebral oxygen supply-consumption balance and energy metabolism in patients during supratentorial tumor resection.Methods Twenty-four patients undergone supratentorial tumor resection,ASA Ⅰ-Ⅱ degree,age 18-65,were randomly divided into control group (Group A,n=12) and the TMP group (Group B,n=12).Group B received 0.9％ sodium chloride 250 ml contained tetramethylpyrazine 80 mg in 20 min when the dural open,while group A was given the same amount of 0.9％ sodium chloride.Blood samples were taken from artery and jugular venous bulb simultaneously before induction of anesthesia (T1),after intubation(T2),opening dura instantly (T3),1 h after opening dura (T4),at the closure of dura (T5),and 24 h after operation (T6),for analyzing the blood-gas and calculating the content of artery blood oxygen,saturation of internal jugular venous bulb blood oxygen,content of internal jugular venous bulb blood oxygen,content of artery-internal differences in oxygen and cerebral extraction ratio oxygen.Glucose extraction ratio,cerebral lactate acid extraction rate,lactate oxygen index.Concentration of internal jugular venous bulb serum S100β,NSE,SOD,MDA.The data of mean artery pressure,heart rate,hematocrit and hemoglobin were recorded at the same time intervals.Results ① Compared with T1 [ (36±5)％,(35±5)％] the cerebral extraction ratio oxygen in both groups were significant decrease at T2 [(24±6)％,(25±5)％],but increased at T6 [(42±5)％,(41±6)％ ](P＜0.05).There were no differences between group A and B at each time intervals.② Compared with T1 [ (6.0±1.0)vol％,(6.4±1.1)vol％ ],there were significant decrease at T2 [ (4.2±1.1)vol％,(4.5±1.0)vol％ ] for the internal jugular venous bulb blood oxygen in both groups,and also at T5 (5.3±0.8)vol％,T6 (5.4±0.8)vol％ (P＜0.05)in group,and there were no differences between group A and B at each time intervals (P＞0.05).③ Compared with T1 [(0.073±0.009)％,(0.067±0.010)％],there were significant decrease for cerebral lactate acid production rate at T2 [ (-0.033±0.008)％,(-0.026±0.007)％ ],T3 [ (-0.031 ±0.006)％,(-0.028±0.005)％ ],T4 [ (.0.025±±0.005)％,(.0.026±0.006)％ ],T5 [(-0.022±0.008)％,(-0.027±0.008)％ ] and T6 [ (0.021±0.005)％),(-0.024±0.003)％] in both groups(P＜0.05).④ Compared with T1 [(0.021 6±0.007 3),(0.022 5±0.007 0) ],-there were significant decrease for lactate oxygen index at T2 [(-0.021 3±0.009 1),(-0.014 1±0.004 1)],T3 [(-0.013 2±0.004 2),(-0.012 3±0.003 3) ],T4 [ (-0.011 4±0.002 9 ),(-0.012 4±0.004 3) ],T5 [ (-0.011 2±0.003 4 ),( 40.014 3±0.005 1 ) ] and T6 [ (-0.010 3±0.003 0 ),(-0.011 0±0.002 0)] in both groups(P＜0.05).⑤ S0D decreased at T3 (77±13),T4 (69±9),T5 (65±12) and T6 (75±14) U/ml compared with T1(99±9) U/ml(P＜0.05)in group A.SOD decreased at T3 (84±12),T4 (79±12),T5 (76±12) U/ml compared with T1 (98±10) U/ml in group B,but with a less decline than group A at the same time intervals (P＜0.05).⑥ There were no differences during each time interval in group A for MDA.While in group B,there were significant decrease at T4 [ (5.6±0.7)vs(6.9±1.3)],T5 [ (5.6±0.5)vs(6.7±1.5)] and T6 [(5.7±0.5)vs (6.5±0.9)] μ mol/L compared with group A at the same time interval (P＜0.05).⑦ S100β at T4 [(1.60±0.43 )vs( 1.81±0.10) ],T5 [ ( 1.60±0.57 )vs(1.86±0.08) ] and T6 [ ( 1.59±0.05 )vs( 1.89±0.07 ) ] μg/L,together with NSE at T4 [ ( 17.4±1.1 )vs(20.3±1.1 ) ]、T5 [ (16.7±1.2)vs(21.3±0.9) ]、T6 [ (15.9±1.2)vs(22.2±0.7) ] μg/L in group B were both decline compared with group A at the same time interval (P＜0.05).Conclusions Under the total intravenous anesthesia during supratentorial tumor surgery,tetramethylpyrazine can increase serum SOD activity and decrease MDA content and serum S100β,NSE concentration.But it did not affect the imbalance of patient's cerebral oxygen supply and demand,and the energy metabolism.
