异丙酚和异氟醚麻醉对颅脑损伤患者围术期血清热休克蛋白70水平的影响

目的 观察异丙酚和异氟醚麻醉对颅脑损伤患者围术期血清热休克蛋白70(HSP70)水平的影响.方法 选择行开颅血肿清除术治疗的中、重型急性颅脑损伤患者30例,按随机数字表法分为异丙酚组和异氟醚组,每组15例.麻醉诱导后前组患者静脉靶控输注异丙酚(效应室靶浓度为3～4μg/ml),后组患者吸入1.2%异氟醚,并且均间断静注维库溴铵、芬太尼维持麻醉深度.应用ELISA法测定患者麻醉诱导前、打开硬脑膜后1 h、术后24 h血液HSP70的含量,记录患者的术后苏醒时间和气管导管拔除时间.结果 2组患者麻醉诱导前、打开硬脑膜后1 h、术后24 h血液HSP70含量随时间的推移均增加,差异有统计学意义(P＜0.05),与异氟醚组比较,异丙酚组患者在打开硬脑膜后1 h和术后24 h时血液HSP70含量较高[(2.00±0.24)ng/ml,(2.19±0.26)ng/ml,t=2.080,P=0.047;(3.57±0.32)ng/ml,(3.81±0.31)ng/ml,t=2.086,P=0.046],术后苏醒进间和气管导管拔除时间较短[(7.7±2.8)min,(5.6±2.7)min,t=2.091,P=0.046;(8.9±3.9)min,(6.0±3.6)min,t=2.116,P=0.043)],差异有统计学意义,＜0.05).结论 静脉靶控输注异丙酚麻醉可维持颅脑损伤患者围术期适度的应激状态.

Abstract：

Objective To investigate the effect of propofol and isoflurane anesthesia on serum heat shock protein 70 ( HSP70 ) of perioperative patients with brain injury and compare the anesthetic effect of the two narcotic drugs. Methods 30 patients with medium or severe traumatic brain injury,treated by hematoma evacuation operation,were randomly divided into propofol ( n = 15 ) and isoflurane group ( n = 15 ). After anesthesia induction,propofol (target effect concentration of 3 ～ 4 μg/ml ) was intravenously injected and 1.2% isoflurane was inhalated into the patients of the 2 groups,respectively. In addition,vecuronium and fentany were intermittent intravenously injected into patients to maintain the depth of anesthesia. HSP70 in blood of patients were detected before anesthesia induction, 1 h after the dura was opened and 24 h after the operation by ELISA method. Recovery and tracheal extubation time of patients were recorded. Results HSP70 levels in blood of patients in the 2 groups were significantly increased compared with the former time point(P＜0.05 ). HSP70 content in propofol group was significantlyhigher at 1 h after the dura was opened( ( 2.00 ± 0. 24 ) ng/ml, ( 2.19 ± 0.26 ) ng/ml, t = 2. 080, P = 0.047 ) and 24 h after the operation( t=2.086, P=0.046) ,and recovery and tracheal extubation time was shorter compared with the isoflurane group(P＜0. 05). Conclusion Perioperative moderate stress,and early postoperative recovery and extubation can be maintained in patients with traumatic brain injury with profol anesthesia.

Effects of propofol and isoflurane anesthesia on serum heat shock protein 70 of perioperative patients with traumatic brain injury

Objective To investigate the effect of propofol and isoflurane anesthesia on serum heat shock protein 70 ( HSP70 ) of perioperative patients with brain injury and compare the anesthetic effect of the two narcotic drugs. Methods 30 patients with medium or severe traumatic brain injury,treated by hematoma evacuation operation,were randomly divided into propofol ( n = 15 ) and isoflurane group ( n = 15 ). After anesthesia induction,propofol (target effect concentration of 3 ～ 4 μg/ml ) was intravenously injected and 1.2% isoflurane was inhalated into the patients of the 2 groups,respectively. In addition,vecuronium and fentany were intermittent intravenously injected into patients to maintain the depth of anesthesia. HSP70 in blood of patients were detected before anesthesia induction, 1 h after the dura was opened and 24 h after the operation by ELISA method. Recovery and tracheal extubation time of patients were recorded. Results HSP70 levels in blood of patients in the 2 groups were significantly increased compared with the former time point(P＜0.05 ). HSP70 content in propofol group was significantlyhigher at 1 h after the dura was opened( ( 2.00 ± 0. 24 ) ng/ml, ( 2.19 ± 0.26 ) ng/ml, t = 2. 080, P = 0.047 ) and 24 h after the operation( t=2.086, P=0.046) ,and recovery and tracheal extubation time was shorter compared with the isoflurane group(P＜0. 05). Conclusion Perioperative moderate stress,and early postoperative recovery and extubation can be maintained in patients with traumatic brain injury with profol anesthesia.