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超.docx

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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超

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【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1μg/kg和异丙酚1mg/kg，继之以异丙酚4~6mg/（kg?h）和瑞芬太尼0．05~0．1μg/（kg?min）维持麻醉。对照组仅静脉注射瑞芬太尼1μg/kg，继之以瑞芬太尼0．05~0．1μg/（kg?min）维持麻醉。分别于麻醉前即刻（T0）、再灌注后1h（T1）、再灌注后3h（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（P0．05），T1时两组血浆ET和MDA浓度较术前均有显著升高（P0．05），T2时观察组血浆ET和MDA浓度较2h前均有显著性降低（P0．05），而对照组均有显著升高（P0．05），T1和T2时组间比较均有统计学意义（P0．05）。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。

【关键词】异丙酚；脑梗塞；缺血再灌注损伤

[Abstract]ObjectiveToinvestigatetheprotectiveeffectofpropofoloncerebralischemia-reperfusioninjuryinpatientswithacutecerebralinfarction.MethodsTwenty-fivepatientswithacutecerebralinfarctionwererandomlypidedintoobservationgroup（n=15）andcontrolgroup（n=10）.Theobservationgroupwasgivenremifentanil1ug/kgandpropofol1mg/kgintravenously，followedbypropofol4-6mg/（kgh）andremifentanil0.05-0.1ug/（kgmin）tomaintainanesthesia.Thecontrolgroupwasgivenremifentanil1ug/kgintravenously，followedbyremifentanil0.05-0.1ug/（kgmin）tomaintainanesthesia.Theconcentrationsofendothelin（ET）andmalondialdehyde（MDA）weremeasuredimmediatelybeforeanesthesia（T0），1hafterreperfusion（T1）and3hafterreperfusion（T2）.ResultsTheplasmaETandMDAlevelsinthetwogroupsbeforeoperationweresignificantlyhigherthanthoseinthenormalgroup（P0.05）.AtT1，theplasmaETandMDAlevelsinthetwogroupsweresignificantlyhigherthanthosebeforeoperation（P0.05）.AtT2，theplasmaETandMDAlevelsintheobservationgroupweresignificantlylowerthanthosebefore2hours（P0.05），whilethoseinthecontrolgroupweresignificantlyhigher（P0.05）.ThereweresignificantdifferencesbetweenthetwogroupsatT1andT2（P0.05）.ConclusionPropofolanesthesiacansignificantlyreduceplasmaendothelinandmalondialdehydelevelsinpatientswithacutecerebralinfarctionafterselectiveintra-arterialthrombolysis，whichmayhaveprotectiveeffectsonhumancerebralischemia-reperfusioninjury.*

[Keywords]Propofol；Cerebralinfarction；Ischemia-reperfusioninjury

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