国际麻醉学与复苏杂志   2012, Issue (9): 3-3
    
川芎嗪对幕上肿瘤切除术患者血清S100β蛋白、神经元特异性烯醇化酶、超氧化物歧化酶和M丙二醇含量及氧供需与能量代谢的影响
李凤仙, 徐世元, 皇甫秀萍, 张庆国, 许睿, 雷洪伊1()
1.南方医科大学珠江医院麻醉科
Effects of tetramethylpyrazine on serum S100β protein, NSE,SOD and MDA content and cerebral oxygen supply-consumption balance and energy metabolism in patients during supratentorial tumor resection
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摘要:

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)、神经原特异性烯醇化酶(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)和川芎嗪组(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盐酸川芎嗪的等量生理盐水。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)vol%,(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 [(-0.0213±0.0091)、(-0.0141±0.0041)]、T3 [(-0.0132±0.0042)、(-0.0123±0.0033)]、T4 [(-0.0114±0.0029)、(-0.0124±0.0043)]、T5 [(-0.0112±0.0034)、(-0.0143±0.0051)]与T6 [ (-0.0103±0.0030)、(-0.0110±0.0020)]均低于T1 [(0.0216±0.0073)、(0.0225±0.0070)],组间各时点间无统计学差异(P>0.05)。⑤ SOD:A组于T3 (77±13)U/ml、T4(69±9)U/ml、T5(65±12)U/ml、T6(75±14)U/ml较T1(99±9)U/ml下降(P<0.05),B组于T3 (84±12)U/ml、T4(79±12)U/ml、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)。 ⑥ MDA: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)] μmol/L、T5 [(5.6±0.5)vs(6.7±1.5)] μmol/L、T6 [(5.7±0.5)vs(6.5±0.9)] μmol/L均低于A组相同时点(P<0.05)。⑦ B组S100β于T4 [(1.60±0.43)vs(1.81±0.10)] μg/L、T5 [(1.60±0.57)vs(1.86±0.08)] μg/L、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)] μg/L、T5 [(16.7±1.2)vs(21.3±0.9)] μg/L、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。

关键词: 幕上肿瘤切除术;川芎嗪;脑保护
Abstract:

Objective To evaluate the effects of intraoperative tetramethylpyrazine(TMP) 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 ⅠⅡ 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), 1hr 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 [(0.0216±0.0073)、(0.0225±0.0070)], there were significant decrease for lactate oxygen index at T2 [(-0.0213±0.0091)、(-0.0141±0.0041)]、T3 [(-0.0132±0.0042)、(-0.0123±0.0033)]、T4 [(-0.0114±0.0029)、(-0.0124±0.0043)]、T5 [(-0.0112±0.0034)、(-0.0143±0.0051)] andT6 [ (-0.0103±0.0030)、(-0.0110±0.0020)] in both groups.(P<0.05). ⑤ SOD decreased at T3 (77±13)U/ml,T4(69±9)U/ml,T5(65±12)U/ml 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)U/ml,T4(79±12)U/ml and 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)] μmol/L, T5 [(5.6±0.5)vs(6.7±1.5)] μmol/L and T6 [(5.7±0.5)vs(6.5±0.9)] μmol/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)] μg/L, T5 [(1.60±0.57)vs(1.86±0.08)] μg/L 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)] μg/L、T5 [(16.7±1.2)vs(21.3±0.9)] μg/L、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, TMP 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.

Key words: Supratentorial tumor resection; Tetramethylpyrazine/ligustrazine;Brain protection