一氧化氮在颅脑损伤手术麻醉期间含量变化及异丙酚的保护作用

目的 探讨急性颅脑损伤（ACI） 患者围术血浆一氧化氮（NO）、一氧化氮合成酶（NOS）、氧自由基（OFR）、脂质过氧化物（LPO）、内皮素（ET）、降钙素基因相关肽（CGRP）含量变化及新型静脉麻醉剂异丙酚（Pro）对其影响。方法 ACI患者40例，根据麻醉方法不同随机分为观察组（异丙酚组）和对照组（α-羟基丁酸钠组）。观察麻醉诱导前、开颅手术去骨瓣后1、3、6、12、24hNOS/NO(分别用T0－T5表示）；麻醉诱导前、开颅手术后1、3hOFR/LPO`ET/CGRP的水平变化。结果 研究发现术前患者血中NO、NOS均高 于正常对照组，其中NOS显著增高；血中OFR、LPO、ET显著高于正常对照组。与对照组相比异丙酚组NO、NOS自妈至经科（T0－T5）呈降低趋势。NOS于开颅手术后1h(T1)达到正常水平，NO于T2时也达到正常水平。FOR、LPO、ET呈显著降低趋势且于T2时达到正常水平。CGRP呈持续升高。结论 ACI患者术前就存在OFR代谢紊乱及NO／NOS、ET／CGRP间含量失衡，开颅手术可导致继发性脑缺血再灌注损害。临床麻醉剂量的Pro具有非选择性NOS抑制剂、OFR清除剂、ET拮抗剂特性，并能提高CGRP水平，具有多途径、多位点脑保护剂特性。

Changes of nitric oxideand protective effects of propofol during neurosurgical anesthesia in patients with acutecerebral injury

Objective To investigate the effects of propofol(Pro) on theplasma contents of nitric oxide (NO),nitric oxide synthase activity(NOS),oxygen free radical(OFR),lipid peroxides(LPO),endothlin(ET) and calcitonin gene related peptide(CGRP) in perioperative patients during neurosurgery.Methods Forty patients with acute cerebral injury(ACI) were divided randomly into receive propofol anesthesia and α-OH as control.Anesthesia was induced with fentanyl,Droperidol,Etomidate and sucinycholine.In Pro group anesthesia was maintained with Pro 6～9 mg/(kg·h), and in control group anesthesia was maintained with α-OH 60 mg/kg. Anesthesia were complex with tramal,Atracurium introvenously.Plasma samples were drawn before anesthesia to 1,3,6,12,24 hours (T0～T5）.Results NOS activity,OFR,LPO,ET were significantly increased before operation in patients with brain tumor or ACI compared to normal value.Compared to control group,propofol group NOS activity (T2～T5)and NO (T3～T5) were significantly decreased compared to T0.Conclusions There are OFR metabolism disorder in patients with ACI before operation.Surgical procedures on the brain may induce secondary cerebral ischemia Therapeutic dose of propofol treated may significantly inhibit that NOS activity and act as an OFR scavenger.Pro markdly antagonistic effect to ET in vivo and increase CGRP level.Possess cerebral protective effect in many ways.