文章摘要
丙泊酚与七氟烷对颅内动脉瘤介入栓塞术患者氧化应激反应及预后的影响
Effects of propofol and seven halothane on oxidative stress and prognosis in patients with intracranial aneurysms undergoing interventional embolization
投稿时间：2019-05-09  修订日期：2019-12-31
DOI：
中文关键词: 丙泊酚  七氟烷  颅内动脉瘤介入栓塞  麻醉  氧化应激反应  预后
英文关键词: Propofol  Sevoflurane  Interventional embolization of intracranial aneurysms  Anesthesia  Oxidative stress reaction  prognosis
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作者单位邮编
高毅；孙丽；张耕瑞；杨丽；温昌明；韩志刚；司小萌* 河南省南阳市中心医院麻醉科 473000 473000
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中文摘要:
      目的：不同麻醉药物的应用可能对患者复苏效果、氧化应激反应及预后效果产生一定影响,本文将观察丙泊酚与七氟烷对颅内动脉瘤介入栓塞患者氧化应激反应及预后的影响,为临床麻醉药物选择提供借鉴。方法：选取2017年1月至2018年5月在南阳市中心医院行全麻下颅内动脉瘤介入栓塞术患者146例作为研究对象,采用随机数字表法将其分为丙泊酚组(73例)和七氟烷组(73例),两组患者均采用右美托咪定、芬太尼和咪达唑仑进行诱导麻醉,丙泊酚组给予持续靶控输注丙泊酚联合右美托咪定维持麻醉,七氟烷组给予持续靶控输注右美托咪定联合吸入七氟烷维持麻醉。比较两组患者睁眼时间、拔管时间及复苏时间；检测两组患者麻醉前(T1)、复苏后12h(T 2)、24h(T 3)、48h(T 4)、72h(T 5)时血清中过氧化物歧化酶(Superoxide dismutase,SOD)、过氧化氢酶(Catalase From Micrococcus Lysodeikticus,CAT)和谷胱甘肽过氧化物酶(Glutathione peroxidase,GSH-Px)活性,并借助格拉斯哥预后评分(Glasgow Outcome Scale,GOS)在术后3个月时对两组患者预后情况进行评价。结果：丙泊酚组患者睁眼时间为(9.9±2.3)min,拔管时间为(13.4±2.8)min,复苏时间为(21.3±3.7)min；七氟烷组患者睁眼时间为(10.1±2.4)min,拔管时间为(12.9±2.7)min,复苏时间为(20.9±3.9)min；上述复苏指标组间比较差异无统计学意义(P＞0.05)。两组患者在T 1时血清中SOD、CAT及GSH-Px活性差异无统计学意义(P＞0.05),两组患者在T 2～T 5时的SOD、CAT及GSH-Px活性显著较T 1时低(P＜0.05)；丙泊酚组SOD和CAT活性在T 2～T 5时明显高于七氟烷组(P＜0.05),GSH-Px活性在T 2～T4时明显高于七氟烷组(P＜0.05)。两组患者预后差异无统计学意义(P＞0.05)。结论：丙泊酚与七氟烷均可作为颅内动脉瘤介入栓塞术患者全麻维持,两者麻醉效果相近,对手术预后无影响；但丙泊酚与七氟烷相比,能够显著减轻颅内动脉瘤介入栓塞术患者的氧化应激反应,减轻脑组织损伤。
英文摘要:
      Objective: The application of different narcotic drugs may have certain effects on resuscitation effect, oxidative stress response and prognosis of patients, The effects of propofol and seven halothane on the oxidative stress response and prognosis of patients with intracranial aneurysms were observed in order to provide reference for the selection of clinical narcotic drugs.Methods: From January 2017 to May 2018, 146 patients with intracranial aneurysm interventional embolization under general anesthesia in Nanyang Central Hospital were selected as the subjects and were divided into propofol group (73 cases) and seven fluorane group (73 cases) by random digital table method. The two groups were induced by dexmedetomidin, fentanyl and midazolam. Propofol group was given continuous target controlled infusion of propofol combined with right metomomidine to maintain anesthesia, and the seven halothane group was given continuous target controlled infusion of right metoamidine combined with inhalation of seven halothane anesthesia. The eye opening time, extubation time and resuscitation time were compared between the two groups, and serum peroxidase dismutase (Superoxide dismutase, SOD) and catalase were detected in two groups before anesthesia (T1), 12h (T 2), 24h (T 3), 48h (T 4), and 72h (T 5). The activity of glutathione peroxidase (Glutathione peroxidase, GSH-Px) and the prognosis of the two groups were evaluated at 3 months after the operation by the Glasgow prognostic score (Glasgow Outcome Scale, GOS).Results: The opening time of the propofol group was (9.9 + 2.3) min, the extubation time was (13.4 + 2.8) min and the resuscitation time was (21.3 + 3.7) min, and the opening time of the seven fluorane group was (10.1 + 2.4) min, the extubation time was (12.9 + 2.7) min and the recovery time was (20.9 + 3.9) min, and the difference of the resuscitation index group was not statistically significant. Meaning (P > 0.05). There was no significant difference in the activity of SOD, CAT and GSH-Px in the two groups at T 1 (P > 0.05). The activity of SOD, CAT and GSH-Px in the two groups was significantly lower than that of T 1 at T 2 to T 5 (P < 0.05), and the activity of propofol group was obviously higher than that of seven fluorane group when 2 ~ 5 was found. The group was higher than the seven fluorothane group (P < 0.05). There was no significant difference in prognosis between the two groups (P > 0.05).Conclusion: Propofol and seven halothane can be used as general anesthesia for patients with intracranial aneurysms. Both of them have similar anesthetic effects and have no effect on the prognosis of the patients. However, propofol can significantly reduce the oxidative stress response and reduce the injury of brain tissue in patients with intracranial aneurysms.
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