异丙酚对急性脑梗塞患者脑缺血再灌注损伤的保护作用(1)
【摘要】 目的 探讨异丙酚对急性脑梗塞患者脑缺血再灌注损伤的保护作用。方法 急性脑梗塞患者25例，拟行数字减影选择性脑动脉内溶栓术，随机分为观察组(n=15)和对照组(n=10)。观察组静脉注射瑞芬太尼1 μg/kg和异丙酚1 mg/kg，继之以异丙酚4~6 mg/(kg•h)和瑞芬太尼0.05~0.1 μg/(kg•min)维持麻醉。对照组仅静脉注射瑞芬太尼1 μg/kg，继之以瑞芬太尼0.05~0.1 μg/(kg•min)维持麻醉。分别于麻醉前即刻(T0)、再灌注后 1 h(T1)、再灌注后3 h(T2)各取静脉血测定内皮素(ET)和丙二醛(MDA)浓度。 结果 术前两组血浆ET和MDA浓度较正常值有显著性升高(P<0.05),T1时两组血浆ET和MDA浓度较术前均有显著升高(P<0.05),T2时观察组血浆ET和MDA浓度较2 h前均有显著性降低(P<0.05)，而对照组均有显著升高(P<0.05)，T1 和T2时组间比较均有统计学意义(P<0.05)。结论选择性脑动脉内溶栓术治疗急性脑梗塞时，异丙酚麻醉可以明显降低患者血浆内皮素和丙二醛浓度，对人体脑缺血再灌注损伤可能具有保护作用。
, 百拇医药
【关键词】异丙酚；脑梗塞；缺血再灌注损伤
Protective effect of propofol against cerebral ischemia-reperfusion injury in patients with acute cerebral infarction
ZHANG Ya-jun,YANG Cheng-xiang,ZHOU Jun,et al.Department of Anesthesiology,Affiliated Foshan Hospital,Zhongshan University,Foshan,Guangdong 528000,China
【Abstract】 Objective To evalue the protective effect of propofol against cerebral ischemia-reperfusion injury in patients with acute cerebral infarction.Methods 25 patients with acute cerebral infarction scheduled to undergo intraarterial thrombolysis were randomly divided into two groups.The patients were administered intravenously with propofol and remifentanil(propofol group,n=15)or remifentanil(control group,n=10)respectively.Plasma endothelin(ET)and malondialdehyde(MDA)concentration were determined before anesthesia,1 and 3 hours following reperfusion.Results Plasma ET and MDA level were significantly increased before anesthesia in two groups compared to normal value.(P<0.05).At one hour following reperfusion ET and MDA level significantly increased in two groups than before anesthsia,at three hours following reperfusion ET and MDA level decreased more than before in propofol group(P<0.05),however,those in control group were markedly increased(P<0.05).ET and MDA level in propofol group at 1 and 3 hours following reperfusion were lower than those in control group respectively(P<0.05).Conclusion Propofol can markedly decrease ET and MDA level in patients with acute cerebral infarctionreceiving intraarterial thrombolysis,so having a protective effect against cerebral ischemia-reperfusion injury.
, 百拇医药
【Key words】Propofol;Cerebral infarction;Cerebral ischemia-reperfusion injury
大量动物实验证明，异丙酚对脑缺血再灌注损伤具有保护作用[1,2]。本文通过研究选择性脑动脉内溶栓术治疗急性脑梗塞时异丙酚对患者血浆内皮素(endothelin,ET)和丙二醛(malondialdehyde，MDA)浓度的影响，探讨异丙酚对人体脑缺血再灌注损伤的保护作用。
1 资料与方法
1.1 一般资料 急性脑梗塞患者25例，拟行数字减影选择性脑动脉内溶栓术，ASAⅡ~Ⅲ级，男14例，女11例，平均(58±9)岁，发病均在6 h以内，无严重高血压、出血倾向和严重糖尿病。临床表现：深昏迷2例，浅昏迷伴失语、偏瘫15例，意识清楚、偏瘫8例。头颅CT排除有颅内出血。数字减影全脑血管造影显示：左颈内动脉梗塞4例,右颈内动脉梗塞3例,左侧大脑前动脉梗塞4例,右侧大脑前动脉梗塞5例,右侧大脑中动脉梗塞5例,右侧大脑后动脉梗塞2例,左侧椎动脉梗塞2例。随机分为观察组(Pro组，n=15)和对照组(Con组，n=10)。
, http://www.100md.com
1.2 方法 术前半小时肌内注射苯巴比妥0.1g，阿托品0.5 mg。术前对照组仅静脉注射瑞芬太尼1 μg/kg，继之以瑞芬太尼0.05~0.1 μg/(kg•min)维持麻醉。观察组静脉注射瑞芬太尼1 μg/kg和异丙酚1 mg/kg，继之以异丙酚4~6 mg/(kg•h)和瑞芬太尼0.05~0.1 μg/(kg•min)维持麻醉。选择性脑动脉内溶栓方法：经皮行股动脉穿刺，导管沿导丝送入脑动脉，予脑血管造影，确定梗塞部位，然后经导管局部注射溶栓剂尿激酶30~50万U，溶于50 ml 0.9%氯化钠溶液中，微泵1 h内输入，观察60 min进行造影。
1.3 监测项目 术中常规监测心电图、无创血压、脉搏血氧饱合度(SpO2)。分别于麻醉前即刻(T0)、再灌注后1 h(T1)、再灌注后3 h(T2)各取静脉血3 ml,立即置于含35 μl 10%EDTA二钠和400 KU抑肽酶的预冷试管中,全血混匀迅速离心(3000 转/min,4℃)，分离血浆置-20℃保存，待测ET和MDA浓度。另抽取20例行腹腔镜胆囊切除术患者静脉血，确定血浆ET和MDA正常值范围。血浆ET浓度采用放射免疫法测定(试剂盒由解放军总医院东亚免疫研究所提供)，仪器采用美国Titertk 10/600全自动r记数仪。MDA浓度测定采用硫代巴比妥酸法。, 百拇医药(张亚军 杨承祥 周 俊 李 恒)
, 百拇医药
【关键词】异丙酚；脑梗塞；缺血再灌注损伤
Protective effect of propofol against cerebral ischemia-reperfusion injury in patients with acute cerebral infarction
ZHANG Ya-jun,YANG Cheng-xiang,ZHOU Jun,et al.Department of Anesthesiology,Affiliated Foshan Hospital,Zhongshan University,Foshan,Guangdong 528000,China
【Abstract】 Objective To evalue the protective effect of propofol against cerebral ischemia-reperfusion injury in patients with acute cerebral infarction.Methods 25 patients with acute cerebral infarction scheduled to undergo intraarterial thrombolysis were randomly divided into two groups.The patients were administered intravenously with propofol and remifentanil(propofol group,n=15)or remifentanil(control group,n=10)respectively.Plasma endothelin(ET)and malondialdehyde(MDA)concentration were determined before anesthesia,1 and 3 hours following reperfusion.Results Plasma ET and MDA level were significantly increased before anesthesia in two groups compared to normal value.(P<0.05).At one hour following reperfusion ET and MDA level significantly increased in two groups than before anesthsia,at three hours following reperfusion ET and MDA level decreased more than before in propofol group(P<0.05),however,those in control group were markedly increased(P<0.05).ET and MDA level in propofol group at 1 and 3 hours following reperfusion were lower than those in control group respectively(P<0.05).Conclusion Propofol can markedly decrease ET and MDA level in patients with acute cerebral infarctionreceiving intraarterial thrombolysis,so having a protective effect against cerebral ischemia-reperfusion injury.
, 百拇医药
【Key words】Propofol;Cerebral infarction;Cerebral ischemia-reperfusion injury
大量动物实验证明，异丙酚对脑缺血再灌注损伤具有保护作用[1,2]。本文通过研究选择性脑动脉内溶栓术治疗急性脑梗塞时异丙酚对患者血浆内皮素(endothelin,ET)和丙二醛(malondialdehyde，MDA)浓度的影响，探讨异丙酚对人体脑缺血再灌注损伤的保护作用。
1 资料与方法
1.1 一般资料 急性脑梗塞患者25例，拟行数字减影选择性脑动脉内溶栓术，ASAⅡ~Ⅲ级，男14例，女11例，平均(58±9)岁，发病均在6 h以内，无严重高血压、出血倾向和严重糖尿病。临床表现：深昏迷2例，浅昏迷伴失语、偏瘫15例，意识清楚、偏瘫8例。头颅CT排除有颅内出血。数字减影全脑血管造影显示：左颈内动脉梗塞4例,右颈内动脉梗塞3例,左侧大脑前动脉梗塞4例,右侧大脑前动脉梗塞5例,右侧大脑中动脉梗塞5例,右侧大脑后动脉梗塞2例,左侧椎动脉梗塞2例。随机分为观察组(Pro组，n=15)和对照组(Con组，n=10)。
, http://www.100md.com
1.2 方法 术前半小时肌内注射苯巴比妥0.1g，阿托品0.5 mg。术前对照组仅静脉注射瑞芬太尼1 μg/kg，继之以瑞芬太尼0.05~0.1 μg/(kg•min)维持麻醉。观察组静脉注射瑞芬太尼1 μg/kg和异丙酚1 mg/kg，继之以异丙酚4~6 mg/(kg•h)和瑞芬太尼0.05~0.1 μg/(kg•min)维持麻醉。选择性脑动脉内溶栓方法：经皮行股动脉穿刺，导管沿导丝送入脑动脉，予脑血管造影，确定梗塞部位，然后经导管局部注射溶栓剂尿激酶30~50万U，溶于50 ml 0.9%氯化钠溶液中，微泵1 h内输入，观察60 min进行造影。
1.3 监测项目 术中常规监测心电图、无创血压、脉搏血氧饱合度(SpO2)。分别于麻醉前即刻(T0)、再灌注后1 h(T1)、再灌注后3 h(T2)各取静脉血3 ml,立即置于含35 μl 10%EDTA二钠和400 KU抑肽酶的预冷试管中,全血混匀迅速离心(3000 转/min,4℃)，分离血浆置-20℃保存，待测ET和MDA浓度。另抽取20例行腹腔镜胆囊切除术患者静脉血，确定血浆ET和MDA正常值范围。血浆ET浓度采用放射免疫法测定(试剂盒由解放军总医院东亚免疫研究所提供)，仪器采用美国Titertk 10/600全自动r记数仪。MDA浓度测定采用硫代巴比妥酸法。, 百拇医药(张亚军 杨承祥 周 俊 李 恒)