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丙泊酚与异氟烷麻醉对急性颅脑外伤患者脑保护作用的比较
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| 篇名： | 丙泊酚与异氟烷麻醉对急性颅脑外伤患者脑保护作用的比较 |
| TITLE： | |
| 摘要： | 目的：比较丙泊酚与异氟烷麻醉对急性颅脑外伤（aTBI）患者的脑保护作用。方法：100例行急诊手术的aTBI患者按随机数字表法分为丙泊酚组和异氟烷组，各50例。两组患者术中分别应用丙泊酚[4～8 mg/（kg·h）]+芬太尼+维库溴铵和异氟烷（吸入浓度0.8％～1.2％）+芬太尼+维库溴铵作为麻醉维持药物。比较两组患者术前、手术进行2 h和手术结束时的血清S100B蛋白和神经元特异性雌烯醇化酶（NSE）水平；并比较两组患者术后6个月的简易精神状态检查量表（MMSE）评分。结果：两组患者手术进行2 h和手术结束时的血清S100B蛋白和NSE水平均较术前显著升高（q＝3.536～4.336，P＜0.05），且在手术结束时丙泊酚组患者的血清S100B蛋白和NSE水平显著低于异氟烷组（t＝3.622、3.845，P＜0.05），差异均有统计学意义。两组患者术后6个月的MMSE评分比较，差异无统计学意义（t＝0.614，P＞0.05）。结论：针对aTBI患者的手术治疗在消除创伤病灶的同时可造成一定的脑组织损害；与应用异氟烷作为麻醉维持药物相比，术中应用丙泊酚作为麻醉维持药物可降低此类脑组织损害程度，发挥更显著的脑保护作用，但对于患者术后神经功能的恢复无增效作用。 |
| ABSTRACT： | OBJECTIVE： To compared protective effects of propofol and isoflurane on cerebral tissue of patients with acute traumatic brain injury （aTBI）. METHODS： 100 aTBI patients underwent emergency surgery were randomly divided into propofol group and isoflurane group with 50 cases. Both groups received propofol [4-8 mg/（kg·h）]+fentanyl+vecuronium bromide and isoflurane [inhalation concentration were 0.8％-1.2％]+fentanyl+vecuronium bromide， respectively. The levels of serum S100B protein and neuron specific nolase （NSE） were compared between 2 groups before surgery， at 2 hour in the surgery and at the end of the surgery. MMSE scale score of 2 groups were compared 6 months after the surgery. RESULTS： At 2nd hour in the surgery and the end of the surgery， the serum S100B and NSE levels of 2 groups were significantly higher than before surgery （q＝3.536-4.336， P＜0.05）. The serum S100B and NSE levels of propofol group at the end of the surgery were significantly lower than in isoflurane group （t＝3.622， 3.845， P＜0.05）， with statistical significance. There was no significant difference in MMSE score between 2 groups at 6 months after the surgery （t＝0.614， P＞0.05）. CONCLUSIONS： When the trauma lesions be eliminated in the surgery， the surgery treatment can cause brain tissue damage of the patients with aTBI at the same time. Compared with the application of isoflurane as the maintained anesthesia drugs， the application of propofol as the maintain anesthesia drugs in the surgery can reduce the degree of such brain tissue damage， play a role in protecting brain more significantly， but put no synergistic effect on the recovery of the postoperative neural function of the patients. |
| 期刊： | 2016年第27卷第14期 |
| 作者： | 程旭东，王镜芳，唐华东，邵浙明 |
| AUTHORS： | CHENG Xudong，WANG Jingfang，TANG Huadong，SHAO Zheming |
| 关键字： | 丙泊酚；异氟烷；急性颅脑外伤；S100B蛋白；神经元特异性烯醇化酶；脑保护作用 |
| KEYWORDS： | Propofol； Isoflurane； Acute traumatic brain injury； S100B protein； Neuron specific nolase； Cerebral protective effects |
| 阅读数： | 345 次 |
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