国际麻醉学与复苏杂志   2018, Issue (6): 4-4
    
参麦注射液对颈动脉内膜切除术老年患者脑组织炎症反应的影响
郭芳, 葛亚丽, 沈邮静, 黄天丰1()
1.扬州大学临床医学院
Effect of Shenmai injection on brain tissue inflammation in elderly patients with carotid endarterectomy
 全文:
摘要：

目的　探讨参麦注射液对颈动脉内膜切除术患者脑组织炎性反应的影响。　方法　全身麻醉下行择期颈动脉内膜切除术的患者50例，年龄≥65岁，ASA分级Ⅱ、Ⅲ级，采用随机数字表法分为2组（每组25例）：参麦注射液组（S组）和对照组（C组）。于麻醉诱导后，S组将参麦注射液0.6 ml/kg加入250 ml生理盐水中静脉输注，C组给予等容量生理盐水。于麻醉诱导前20 min（T0）、麻醉诱导后10 min（T1）、颈动脉夹闭15 min（T2）、颈动脉开放15 min（T3）、术后6 h（T4）、术后24 h（T5）时抽取患侧颈内静脉球部血样，采用硫代巴比妥酸法检测血清丙二醛（malondialdehyde, MDA）浓度，采用ELISA法检测血清S100β、TNF-α和IL-6的浓度；并于以上时间点行桡动脉及颈内静脉球部血气分析，计算颈内静脉血氧饱和度（jugular venous oxygen saturation, SjvO2）及动脉-颈内静脉血氧含量差（cerebral arterial-jugular venous oxygencontent difference, Da-jvO2）。　结果　2组间T0~T5时SjvO2和Da-jvO2比较，差异无统计学意义（P>0.05）。2组间T0、T1时血清S100β、TNF-α、IL-6、MDA浓度比较，差异无统计学意义（P>0.05）。与T0时比较，2组患者T3~T5时S100β浓度升高，T2~T5时血清IL-6浓度升高，T3、T4时血清MDA浓度升高，C组T2~T5及S组T3、T4时TNF-α浓度升高（P<0.05）。与C组比较，S组患者T3~T5时血清S100β浓度降低，T2~T5时血清TNF-α和IL-6浓度降低，T3、T4时血清MDA浓度降低（P<0.05）。　结论　参麦注射液可通过抑制颈动脉内膜切除术患者脑组织炎性反应减轻脑损伤。
关键词： 参麦注射液；　炎症；　脑；　颈动脉内膜切除术
Abstract:

Ｏｂｊｅｃｔｉｖｅ　To investigate the effect of Shenmai injection on the inflammatory response of brain tissue in patients with carotid endarterectomy.　Methods　A total of fifty ASA physical statusⅡor Ⅲ patients, scheduled for elective unilateral carotid endarterectomy under general anesthesia, were randomly divided into 2 groups(n=25) using a random number table： Shenmai injection group (group S) and control group (group C). Group S was given Shenmai injection 0.6 ml/kg after the anesthesia induction, adding 250 ml of saline intravenous infusion. Group C was given equal volume of saline. 20 min before the anesthesia induction (T0), 10 min after anesthesia induction (T1), 15 min after carotid artery occlusion(T2), 15 min after carotid artery open(T3), 6 h after operation(T4), 24 h after operation (T5). Malondialdehyde(MDA) concentration was measured by thiobarbituric acid method. The concentrations of serum S100β, TNF-α and IL-6 were measured by ELISA. At the same time, the concentration of serum S100β, TNF-α and IL-6 were measured by ELISA. Jugular venous oxygen saturation (SjvO2) and cerebral arterial-jugular venous oxygen content difference(Da-jvO2) were measured by the blood gas analysis of radial artery and internal jugular vein.　Results　There was no significant difference in SjvO2 and Da-jvO2 between the two groups at T0-T5(P>0.05). There was no significant difference in serum S100β, TNF-α, IL-6, MDA concentration between the two groupsat T0, T1(P>0.05). Compared with T0, the concentration of S100β increased at T3-T5 and the level of serum IL-6 increased at T2-T5. Also, the serum MDA concentrations were increased at T3, T4， the concentration of TNF-α increased in group C at T2-T5 and in group S at T3, T4(P<0.05). Compared with group C, serum S100β concentration decreased in group S, levels of TNF-α and IL-6 decreased at T2-T5, and serum MDA concentration decreased at T3, T4(P<0.05).　Conclusions　Shenmai injection can reduce the brain injury by inhibiting the inflammatory response of the brain tissue in patients with carotid endarterectomy.
Key words: Shenmai injection;　Inflammation;　Brain;　Carotid endarterectomy