依托咪酯与丙泊酚麻醉对行颅内动脉瘤介入术患者氧化应激及脑损伤的影响

摘要

Objective To explore the effects of etomidate and propofol anesthesia on oxidative stress and brain injury in patients undergoing intracranial aneurysm interventional operation.Methods Eighty patients undergoing intracranial aneurysm interventional operation from january 2015 to June 2016 in the First People's Hospital of Yibin were randomly divided into etomidate group and propofol group,with 40 cases in each group.All patients were treated with the same anesthesia induction;the propofol group had propofol 2-4 mg/L and the etomidate group had etomidate 0.3-0.6 mg/(kg · h) for anesthesia maintenance.Levels of superoxide dismutase(SOD),catalase(CAT),glutathione peroxidase(GSH-Px),neuro-specific enolase(NSE),S100β,mean arterial pressure and heart rate were analyzed.Results Levels of SOD,CAT and GSH-Px at 24,48,72 h after operation in etomidate group were significantly higher than those in propofol group;levels of NSE and S100β at 24,48,72 h after operation in etomidate group were significantly lower than those in propofol group(P ＜ 0.05).Mean arterial pressure and heart rate before and during intubation in propofol group were significantly lower than those in etomidate group;mean arterial pressure and heart rate during extubation in propofol group were significantly higher than those in etomidate group [mean arterial pressure:(112 ± 22) mmHg vs (119 ± 23) mmHg,(105 ± 25) mmHg vs (126 ± 24) mmHg,(133 ± 27) mmHg vs (125 ± 23) mmHg;heart rate:(80 ± 12) times/min vs (87 ± 12) times/min,(78 ±12) times/min vs (87 ± 12)times/min,(97 ± 15)times/min vs (85 ± 11)times/min] (P ＜0.05).Conclusion Etomidate anesthesia can reduce stress response and protect the brain more significantly than propofol in patients undergoing cerebral aneurysm interventional operation.%目的 探讨依托咪酯与丙泊酚麻醉对行颅内动脉瘤介入术患者氧化应激及脑损伤的影响.方法 选择2015年1月至2016年6月于四川省宜宾市第一人民医院行颅内动脉瘤介入治疗的患者80例,按照随机数字表法分为依托咪酯组和丙泊酚组,各40例.所有患者采用相同的麻醉诱导方式,麻醉维持阶段丙泊酚组采用靶控输注丙泊酚2 ～4 mg/L,依托咪酯组给予依托咪酯0.3～0.6 mg/(kg·h).比较2组患者围术期超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GSH-Px)、神经特异性烯醇化酶(NSE)、S100β蛋白、平均动脉压和心率水平.结果 术后24、48、72 h,依托咪酯组患者SOD、CAT、GSH-Px水平均高于丙泊酚组,NSE和S100β水平均低于丙泊酚组,差异均有统计学意义(均P＜0.05).丙泊酚组插管前、插管即刻平均动脉压和心率均明显低于依托咪酯组,拔管时平均动脉压和心率均明显高于依托咪酯组[平均动脉压:(112±22)mmHg(1 mmHg =0.133 kPa)比(119 ±23)mmHg、(105±25) mmHg比(126±24) mmHg、(133±27) mmHg比(125±23) mmHg;心率:(80±12)次/min比(87±12)次/min、(78±12)次/min比(87±12)次/min、(97±15)次/min比(85±11)次/min],差异均有统计学意义(均P ＜0.05).结论 依托咪酯麻醉能够有效降低颅内动脉瘤介入手术患者应激反应,有效保护脑组织,效果优于丙泊酚.