右美托咪定对脑胶质瘤切除术患者脑氧摄取率及脑脊液氨基酸的影响

目的观察右美托咪定对脑胶质瘤切除术患者脑氧摄取率(CERO_2)及脑脊液氨基酸的影响。方法选取脑胶质瘤切除术患者60例,以随机单盲法分为试验组、对照组,各30例。全麻基础上,试验组予以右美托咪定,对照组予以等量生理盐水。对比2组麻醉前(T_0)、气管插管时(T_1)、开颅时(T_2)、术毕时(T_3)的血流动力学(心率、平均动脉压)、CERO_2及术前、术后6 h、术后24 h的脑脊液氨基酸[抑制性氨基酸γ-氨基丁酸(GABA)、兴奋性氨基酸天门冬氨酸(Asp)、谷氨酸(Glu)]水平。结果试验组T_1、T_2时心率、平均动脉压水平较T0时降低,且低于对照组(P0.05);试验组T_1、T_2、T_3时CERO_2水平较T0时升高,且高于对照组(P0.05);试验组术后6 h、术后24 h的脑脊液GABA水平高于对照组,Asp、Glu水平低于对照组(P0.05)。结论右美托咪定应用于脑胶质瘤切除术患者可升高CERO_2,维持血流动力学平稳,改善脑脊液氨基酸表达,起到脑保护作用。     

右美托咪定对急性颅脑损伤患者脑功能及血流动力学的影响

目的研究右美托咪定对急性颅脑损伤患者脑功能及血流动力学产生的影响。方法抽取2015-09―2017-01登封市人民医院收治的94例接受开颅血肿清除联合去骨瓣减压术急性颅脑损伤病例为研究对象,依据术后镇静药物差异,分为A组与B组各47例,A组予以右美托咪定,B组予以咪达唑仑,比较2组术前与术后24 h格拉斯哥昏迷评分(GCS)、格拉斯哥预后评分(GOS)、神经元特异烯醇化酶(NSE)浓度、术后各时刻心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)。结果术前2组GCS评分及血清NSE浓度对比无显著性差异(P0.05);术后24 h,A组GCS评分与GOS评分显著高于B组,NSE浓度明显低于B组(P0.05);T0时刻,2组HR、SBP、DBP及MAP对比无显著性差异(P0.05);T1、T2、T3时刻,A组HR、SBP、DBP及MAP均明显小于B组(P0.05)。结论右美托咪定治疗可保护急性颅脑损伤患者脑功能,并维持血流动力学指标的稳定,优化预后。     

右美托咪定在冠状动脉旁路移植术中对脑功能的影响

目的探讨右美托咪定(Dex)对冠状动脉旁路移植术中脑功能的影响。方法选择体外循环下冠状动脉旁路移植术患者60例,随机分为右美托咪定组(A组)和对照组(B组)。观察术前(T0)、气管插管后3min(T1)、转流前即刻(T2)、停机后即刻(T3)、手术结束时(T4)血清肾上腺素(E)、去甲肾上腺素(NE)、S-100β蛋白和神经元特异性烯醇化酶(NSE)浓度。结果与T0比较,B组血清E、NE浓度在T1~T4时升高(P0.05),B组血清S-100β、NSE浓度在T3~T4时升高(P0.05)。与A组比较,B组血清E、NE浓度在T1~T4时升高(P0.05),B组血清S-100β、NSE浓度在T3~T4时升高(P0.05)。结论 Dex可以降低体外循环下冠状动脉旁路移植术中S-100β和NSE浓度,抑制E和NE释放,其脑保护机制可能与抑制应激反应有关。     

右旋美托咪定对脑胶质瘤患者围术期免疫功能的影响

脑胶质瘤患者免疫功能受到抑制,手术与麻醉等因素可加重其抑制程度。右旋美托咪定作为新型的α-2肾上腺受体激动剂,广泛用于麻醉期间及危重症患者的镇静等。研究发现右旋美托咪定可通过减轻机体应激、炎症反应,调节T细胞功能,减少S100β蛋白、白细胞介素-6等因子的生成,围术期应用可保护甚至改善胶质瘤患者的免疫功能,可能抑制肿瘤形成、增殖及生存,为提高治疗效果、改善患者预后提供了新思路,为围术期右旋美托咪定的应用开拓了新的前景。     

右美托咪定诱导麻醉对高血压脑出血患者脑功能的影响

目的分析研究右美托咪定诱导麻醉对高血压脑出血患者术中体征及术后脑功能的影响。方法选取我院2015-02—2017-02收治的88例高血压脑出血患者进行研究,随机分为对照组和观察组各44例。观察组在麻醉诱导前静脉给予右美托咪定治疗,对照组给予等量的生理盐水,对比2组不同时间点HR、SBP、DBP、MAP水平及不良反应发生情况和术后脑功能恢复情况。结果 2组患者入室时各指标相比差异无统计学意义(P0.05),在诱导前、插管后、切皮时及自主呼吸恢复时各时间点的HR、SBP、DBP、MAP水平等指标均显著低于对照组(P0.05);2组患者术前S100β蛋白水平及NSE水平相比差异无统计学意义(P0.05),但观察组术后0h、术后6h、术后12h、术后24h各时间点均显著低于对照组,2组相比差异均有统计学意义(P0.05);观察组术后不良反应发生率显著高于对照组(P0.05)。结论右美托咪定诱导麻醉可以有效改善患者的心率和血压,同时可以维持患者血流动力学指标的稳定,且对患者脑功能具有保护作用,值得临床推广。     

右美托咪定对重症颅脑损伤术后患者脑氧代谢率和脑血流的影响

目的分析在血压稳定前提下使用右美托咪定对重症颅脑损伤术后患者进行镇静过程中脑氧代谢率、脑血流量的影响。方法选取54例重症颅脑损伤术后患者,根据格拉斯哥昏迷评分分为中度组(GCS6～8分) 29例和重度组(GCS3～5分) 25例,选取同时期GCS 9～12分颅脑损伤术后患者20例为对照组。所有患者采用升压药物维持血压在基础水平的前提下,给予右美托咪定镇静治疗。分别在镇静前(t_p)、镇静后60 min (t_(60))及停用右美托咪定后2 h(t_(2 ))测定脑血流量,t_p及t_(60)时计算脑氧代谢率。同时记录t_(p、)t_(60)、t_2时间点的HR、RR、SpO_2、PaCO_2、MAP及Riker镇静躁动评分。结果与t_p相比,3组t_(60)和t_2时间点脑血流量、脑氧代谢率及脑血流量/脑氧代谢率差异均无统计学意义(P0.05);与t_(60)相比,3组t_2时间点的脑血流量、脑氧代谢率及脑血流量/脑氧代谢率差异均无统计学意义(P0.05)。与t_p相比,3组患者在t_(60)和t_2时间点的HR、MAP、RR、SpO_2及PaCO_2差异无统计学意义(P0.05)。给予右美托咪定镇静后,对照组、中度组、重度组患者多巴胺用量分别为(70.23±23.79) mg、(70.08±12.59) mg、(69.97±19.96) mg;3组多巴胺用量无显著性差异(P0.05)。对照组、中度组、重度组患者t_p RASS评分分别为5.82±1.08、5.74±1.08、3.34±1.58,t_(60) RASS评分分别为3.08±1.11、2.83±0.59、1.69±0.93,与t_p相比,3组患者t_(60)时间点的RASS评分明显降低,差异有统计学意义(P0.05)。结论在维持血压水平的前提下右美托咪定用于重症颅脑损伤的镇静对患者的脑血流量和脑氧代谢率无明显影响,是安全有效的。     

右美托咪定对感染性休克大鼠的脑保护作用研究

目的探究右美托咪定(DEX)对感染性休克大鼠的脑保护作用。方法将30只大鼠随机分成3组(n=10),对照组、脂多糖(LPS)处理组(LPS组)、右美托咪定组(DEX组)。LPS组在大鼠腹腔注射10mg·kg~(-1) LPS构建感染性休克大鼠模型;对照组注入等量生理盐水;DEX组在造模前对大鼠腹腔注入50μg·kg~(-1) DEX预处理1h。检测大鼠海马体匀浆液中肿瘤坏死因子-α(TNF-α)和白细胞介素6(IL-6)的表达量,比较各组大鼠海马区锥体细胞病理学结果,观察海马体匀浆液中细胞凋亡情况,通过Western bolt蛋白分析大鼠海马区域中核转录因子(NF-kB)的表达量。结果与LPS组相比,DEX组大鼠海马体匀浆液中的TNF-α和IL-6含量增加,大鼠海马区锥体细胞病理程度和细胞凋亡率显著降低(P0.05),Western blot结果表明50μg·kg~(-1) DEX能够显著降低LPS诱导后大鼠海马区中NF-kB的表达量。结论 DEX可能通过抑制NF-kB活化来发挥对感染性休克大鼠的脑保护作用。     

右美托咪定对严重颅脑损伤患者围手术期炎性因子及脑氧代谢的影响

目的探讨右美托咪定对严重颅脑损伤患者围手术期炎性因子反应及脑氧代谢的影响。方法选取我院2014-05—2016-07收治的59例严重颅脑损伤患者,随机分为对照组29例,观察组30例,对照组予以阿曲库铵、丙泊酚、咪达唑仑、芬太尼常规麻醉诱导,观察组于对照组基础上加用右美托咪定,观察2组白细胞介素-10(IL-10)、IL-8、IL-6、肿瘤坏死因子-α(TNF-α)水平及脑氧含量(CjvO_2)、动脉-颈内静脉球部血氧差[D(a-jv)O_2]、脑氧摄取率(CEO_2),并统计预后良好率。结果治疗后观察组IL-10水平高于对照组,IL-8、IL-6及TNF-α均低于对照组,差异有统计学意义(P0.05);治疗后观察组CjvO_2高于对照组,D(a-jv)O_2及CEO2低于对照组,差异有统计学意义(P0.05);观察组预后良好率53.33%,高于对照组的27.59%,差异有统计学意义(P0.05)。结论右美托咪定治疗严重颅脑损伤,可有效改善患者炎性因子水平及脑氧代谢状态,预后良好率高。     

右美托咪定对神经外科手术患者围术期血清TNF-α和IL-6的影响

目的观察右美托咪定对神经外科手术患者围术期血清TNF?α和IL-6的影响。方法研究对象为我院2014-03—2015-11收治的102例颅内动脉瘤患者,按随机数字表法分成观察组(51例)与对照组(51例)。对照组术前和术后泵注生理盐水;观察组麻醉诱导前泵注右美托咪定1μg/kg,结束后以0.4μg/(kg·h)右美托咪定泵注,比较2组不同时刻血流动力学指标HR和MAP水平,对比2组不同时刻IL-6和TNF?α水平。结果诱导后,观察组IL-6、TNF?α及HR水平均较对照组明显降低,MAP水平较对照组显著升高,差异均有统计学意义(P0.05)。结论右美托咪定在神经外科手术中具有较高的应用价值,能够稳定患者的血流动力学,降低机体炎性介质的水平,减轻炎症反应,从而促进患者术后的康复预后。     

右美托咪定对颅内动脉瘤全麻下介入术后拔管期血流动力学的影响

目的 观察右美托咪定对全麻下颅内动脉瘤介入术后拔管期血流动力学的影响.方法 回顾性分析2016年1月至2018年12月全麻下介入治疗的66例颅内动脉瘤的临床资料,其中33例术后应用右美托咪定治疗(观察组),33例未应用右美托咪定治疗(对照组).记录拔除气管插管前(T1)、拔管时(T2)、拔管后5min(T3)、拔管后3...     

Concentrations of sulfur-containing free amino acids in lumbar cerebrospinal fluid from patients with consciousness disturbances

The concentrations of sulfur-containing amino acids (taurine, methionine, cystine, cystathionine, homocystine) in lumbar CSF from patients with consciousness disturbances and controls were measured, and it was investigated whether there was any correlation between the sequential changes of these amino acid concentrations and of the level of consciousness. In all patients, thyrotropin-releasing hormone (TRH) was administered and the changes of levels of consciousness and amino acid concentrations were followed before and after administration. The concentrations of taurine and cystathionine from the patients were significantly lower, and methionine and cystine significantly higher than those from the controls; they returned to the control values in parallel with improvement of consciousness level. Homocystine was not detected in either patients or controls. These results suggest that the alteration in the level of consciousness is associated with distortion of sulfur-containing amino acid metabolism within the central nervous system, at least in the CSF.     

脑梗塞患者血及脑脊液中兴奋性氨基酸递质的动态观察

目的观察脑梗塞患者血及脑脊液（ＣＳＦ）中兴奋性氨基酸浓度的动态变化,并探讨其变化规律及临床意义。方法应用高效液相色谱系统,测定了１０例正常对照组和４１例脑梗塞患者起病后７ｈ～１０ｄ的血和ＣＳＦ中谷氨酸（Ｇｌｕ）和天门冬氨酸（Ａｓｐ）浓度的变化。结果Ｇｌｕ及Ａｓｐ的浓度在２４ｈ后开始明显升高,３ｄ达高峰,５ｄ后开始下降,７ｄ后基本接近正常水平。同时发现脑梗塞后血和ＣＳＦ中Ｇｌｕ含量呈正相关。ＣＳＦ中Ｇｌｕ浓度的变化与梗塞直径、病程和神经功能评分也呈显著相关。结论Ｇｌｕ和Ａｓｐ在脑梗塞的病理过程中起着重要作用。血和ＣＳＦ中Ｇｌｕ和Ａｓｐ浓度可以作为临床观察病情变化、梗塞面积及病程演变的客观指标。     

Decreased cerebrospinal fluid levels of neutral and basic amino acids in patients with Parkinson''s disease

We measured the CSF levels of 21, and the plasma levels of 26, amino acids in 31 patients with Parkinson's disease (PD) and in 45 matched controls. We used an ion-exchange chromatography method. When compared to controls, PD patients had lower CSF levels of taurine, alanine, valine, leucine, isoleucine, ethanolamine, citrulline, ornithine, lysine, histidine, arginine, and alpha-aminobutyric acid. PD patients not treated with levodopa or with dopamine agonists had higher CSF tyrosine and phenylalanine levels than those not treated with these drugs and also than controls. PD patients had higher plasma levels of phosphoserine, threonine, methionine, tyrosine, sarcosine and -aminoadipic acid, and lower plasma levels of valine, leucine, and tryptophan, than controls. The CSF/plasma ratio of many of these amino acids was significantly lower in PD patients than those of controls, suggesting that PD patients might have a dysfunction in the transport of neutral and basic amino acids across the blood–brain barrier.     

急性颅脑损伤后脑脊液中递质类氨基酸变化

目的 从临床角度探讨急性颅脑损伤后脑脊液中递质类氨基酸的变化与损伤程度的临床关系。方法 急性脑外伤患者按入院时格拉斯哥昏迷评分(GCS)分为轻、中型组(35例)和重型组(33例)，分别于伤后入院第1d、第3d、第7d采集脑脊液标本，同时取正常脑脊液样本作对照组，用高压液相色谱(HPLC)法检测其中6种递质氨基酸即天冬氨酸(Asp)、谷氨酸(Glu)、牛磺酸(Tau)、甘氨酸(Gly)、γ—氨基丁酸(GABA)和丙氨酸(Ala)的含量变化并作相关分析。结果 重型组脑脊液中Asp、Glu、Gly、GABA、Tau和轻、中型组脑脊液中Asp、GABA、Tau3次取样浓度均高于对照组。轻、中型组脑脊液中Glu浓度第1d和第3d高于对照组，第7d下降至与对照组不存在显著差异，而该组Gly始终与对照组不存在差异。重型组Asp、Glu、Gly、Tau3次取样浓度均高于轻、中型组。GABA重型组第1d高于轻、中型组，第3d与轻、中型组浓度无显著性差异，第7d再次显著高于轻、中型组。Ala3次取样两患病组之间无显著差异，轻、中型组均较对照组降低，重型组除第7d低于对照组外，前两次取样较对照组无显著差异。结论 兴奋性氨基酸的增高和其神经毒性作用与颅脑损伤程度以及病理生理过程密切相关，抑制类氨基酸在颅脑损伤后的反应性改变可能起到脑保护作用，其机制需进一步探讨。     

Inhibitory and excitatory amino acids in the cerebrospinal fluid of children with two types of cerebral palsy*

BACKGROUND： Under normal conditions, excitatory amino acids are dynamically balanced with inhibitory amino acids. Excitatory amino acids have been implicated in perinatal brain injury. OBJECTIVE： To investigate differences in the levels of the excitatory amino acids glutamic acid and aspartic acid, and the inhibitory amino acid gamma-aminobutyric acid （GABA） in the cerebrospinal fluid （CSF） of children with spastic cerebral palsy or athetotic cerebral palsy. DESIGN, TIME AND SETTING： Case-control exploratory observation of neurotransmitter in patients. The experiment was performed in the Pediatrics Department of the Second Affiliated Hospital of Changsha Medical College, the Cerebral Palsy Center of Xiangtan Affiliated Hospital of South China University and the Pediatrics Department of Xiangya Hospital, between February 2006 and May 2007. PARTICIPANTS： We selected 27 children with cerebral palsy, including 13 with spastic cerebral palsy and 14 with athetotic cerebral palsy. We selected 10 patients who were not affected by any neurological disease as controls. METHODS： Two mL blood-free CSF was harvested between the third and fourth lumbar vertebrae of each patient after anesthesia, and stored at -70℃. One mL CSF was mixed with 10 mg sulfosalicylic acid and placed in ice-bath for 10 minutes, then centrifuged 2 000 g for 10 minutes. The supernatant was collected for amino acid quantitation. MAIN OUTCOME MEASURES： The concentrations of glutamic acid, aspartic acid and GABA in the CSF were determined by high-performance liquid chromatography and fluorometric method. The correlation of glutamic acid, aspartic acid and GABA levels with muscular tension in children with cerebral palsy was analyzed using linear dependence. RESULTS： The concentration of GABA was significantly lower in both spastic cerebral palsy and athetotic cerebral palsy patients than in the control group （P 〈 0.01）. Glutamic acid and aspartic acid were significantly higher in both cerebral palsy groups than in the control     

脑脊液外泌体miR-146a与人脑胶质瘤术后复发的相关性

目的 探讨脑脊液外泌体miR-146a与人脑胶质瘤术后复发的相关性.方法 收集2016年5月～2017年5月经术后病理证实的70例脑胶质瘤(低级别胶质瘤31例,高级别胶质瘤39例)和25例颅脑损伤(对照组)的脑脊液,采用PCR检测脑脊液外泌体miR-146a表达水平.胶质瘤病人术后随访1～36个月,记录术后复发情况.结...     

Neurotransmitter amino acids in cerebrospinal fluid of patients with Alzheimer's disease

Summary. We measured the CSF and plasma levels of glutamate, glutamine, aspartate (only in plasma), asparagine, glutamine, glycine and GABA in 37 patients with Alzheimer's disease and in 32 matched controls. We used an ion-exchange chromatography method. When compared to controls, AD patients had higher CSF glutamate and glycine levels, higher plasma levels of aspartate and glycine, and lower plasma levels of asparagine and GABA. When expressed relative to CSF proteins, CSF levels of glutamate and glycine remained higher, and CSF asparagine levels were lower in AD patients than in controls. The CSF levels of the amino acids measured were not correlated with the clinical features of AD with the exception of plasma GABA levels with duration of the disease. Our results might suggest a possible pathogenetic role of neurotransmitter amino acids in AD. Accepted December 2, 1997; received August 30, 1997     

Amino acid transport across the human blood-CSF barrier. An evaluation graph for amino acid concentrations in cerebrospinal fluid

The correlation of cerebrospinal fluid (CSF)/serum concentration quotients was used as a method for identification of amino acids which are transported by a common carrier system across the blood-CSF barrier. Isoleucine, leucine, valine, phenylalanine, tyrosine and lysine were found to compete for the same carrier system. This group of amino acids in man was found to be different from the system described as a neutral amino acid carrier at the blood-brain barrier in rats. In man, methionine and tryptophan do not compete with the other neutral amino acids for the same carrier system. In contrast, lysine as a basic amino acid is found to be correlated with the same transport system as the five neutral amino acids. A graph for the evaluation of pathological amino acid concentrations in CSF is presented. Patients with a blood-CSF barrier dysfunction for proteins showed partly normal, partly increased, CSF/serum concentration quotients for the amino acids. Hydroxyproline could be identified as a constituent of the amino acid pool in CSF. For proline and hydroxyproline a special control system has to be suggested because of their smaller biological variance in CSF than in blood. Contrary to the other amino acids proline and hydroxyproline have a smaller biological variation in CSF than in serum.