异丙酚对急性脑梗塞患者脑缺血再灌注损伤的保护作用

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1、异丙酚对急性脑梗塞患者脑缺血再灌注损伤的保护作用作者：张亚军　杨承祥　周俊　李恒　　【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/(kgR

2、26;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(P<0．05),T1时两组血浆ET和MDA浓度较术前均有显著升高(P<0．05),T2时观察组血浆ET和MDA浓度较2h前均有显著性降低(P<0．05)，而对照组均有显著升高(P<0．05)，T1和T2时组间比较均有统计学意义(P<0．05)。结论选择性脑动脉内溶栓术治疗急性脑梗塞时，异丙

3、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】ObjectiveToevaluetheprotectiveeffect8ofpropofolagainstcerebralischemia-reperfusioninjuryinpatientswithacutecerebralinfarction.Methods25patientswithacutecerebralinfarctionscheduled

4、toundergointraarterialthrombolysiswererandomlydividedintotwogroups.Thepatientswereadministeredintravenouslywithpropofolandremifentanil(propofolgroup,n=15)orremifentanil(controlgroup,n=10)respectively.Plasmaendothelin(ET)andmalondialdehyde(MDA)concentrationwere

5、determinedbeforeanesthesia,1and3hoursfollowingreperfusion.ResultsPlasmaETandMDAlevelweresignificantlyincreasedbeforeanesthesiaintwogroupscomparedtonormalvalue.(P<0．05).AtonehourfollowingreperfusionETandMDAlevelsignificantlyincreasedintwogroupsthanbeforeanes

6、thsia,atthreehoursfollowingreperfusionETandMDAleveldecreasedmorethanbeforeinpropofolgroup(P<0．05),however,thoseincontrolgroupweremarkedlyincreased(P<0．05).ETandMDAlevelinpropofolgroupat1and3hoursfollowingreperfusionwerelowerthanthoseincontrolgrouprespect

7、ively(P<0．05).ConclusionPropofolcanmarkedlydecreaseETandMDAlevelinpatientswithacutecerebralinfarctionreceivingintraarterialthrombolysis,sohavingaprotectiveeffectagainstcerebral8ischemia-reperfusioninjury.　　【Keywords】Propofol;Cerebralinfarction;Cerebralisch

8、emia-reperfusioninjury　　　　大量动物实验证明，异丙酚对脑缺血再灌注损伤具有保护作用[1,2]。本文通过研究选择性脑动脉内溶栓术治疗急性脑梗塞时异丙酚对患者血浆内皮素(endothelin,ET)和丙二醛(malondialdehyde，MDA)浓度的影响，探讨异丙酚对人体脑缺血再灌注损伤的保护作用。　　1资料与方法　　1．1一般