大面积脑梗死患者血清NO和NOS活性在去骨瓣减压术前、术后变化分析

目的：探讨血清NO和NOS活性在急性大面积脑梗死（ACI）患者手术前后的变化规律。方法：急性大面积脑梗死患者18例,均采用全麻开颅去骨瓣减压手术,分别于术前1h,术后1、12、72h采集静脉血5ml各2份。分别检测NO含量和NOS活性。结果：本组患者18例术后3d内无死亡病例,术后患者意识不同程度改善;NO含量和NOS活性术前和术后1h差异均无统计学意义（P〉0.05）,术后24h和72h均出现进行性下降,与术前比较,差异均有统计学意义（P〈0.05）,术后72h明显低于术后24h,差异均有统计学意义（P〈0.05）。结论：去骨瓣减压是治疗急性大面积脑梗死的有效治疗手段,能够减低患者的死亡率;NO和NOS参与并影响了ACI后复杂的病理生理过程,去骨瓣减压后局部脑血供得到有效改善,NOS活性减低,合成NO减少,神经毒性减低,临床症状好转。

Changes of NO and NOS activity in the patients, serum of massive cerebral infarction with decompressive craniectomy during the preoperative and postoperative

Objective：To study the change of NO and NOS activity in patients with acute massive cerebral infarction before and after surgery.Methods：18 cases with acute massive cerebral infarction were used anesthesia craniotomy decompression craniectomy.The two serum samples were collected with 5 ml every copy 1 h before surgery,and 1,12,72 h after surgery.NO content and NOS activity were measured.Results：18 cases survived within 3 days after surgery,and all the cases had an improvement with varying degrees of consciousness.NO content and NOS activity were not significantly different between 1 h before surgery and 1 h after surgery（P0.05）,and they appeared to decrease both 24 h and 72 h after surgery,compared with the preoperative,and the differences were statistically significant（P0.05）.72 h after surgery was significantly lower than 24 h with the statistically significant difference（P0.05）.Conclusion：It is the effective treatment for the decompressive craniectomy to cure the acute massive cerebral infarction.It could reduce mortality.NO and NOS participated in and influenced the complex pathophysiological process of massive cerebral infarction.It is the effective improvement of regional cerebral blood after decompressive craniectomy,and NOS activity reduced the synthesis of NO,and then there is reduction to neurotoxicity and improvement in clinical symptoms.