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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/(kg.min)维持麻醉。分别于麻醉前即刻(T0)、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。
Objective To investigate the protective effect of propofol on cerebral ischemia-reperfusion injury in patients with acute cerebral infarction. Methods Twenty - five patients with acute cerebral infarction were enrolled in this study. Digital subtraction and selective intracerebral thrombolysis were randomly divided into observation group (n = 15) and control group (n = 10). The observation group was given intravenous remifentanil 1μg / kg and propofol 1mg / kg, followed by propofol 4 ~ 6mg / (kg.h) and remifentanil 0.05 ~ 0.1μg / (kg.min) to maintain anesthesia. The control group received intravenous remifentanil 1μg / kg, followed by remifentanil 0.05 ~ 0.1μg / (kg.min) to maintain anesthesia. The concentrations of endothelin (ET) and malondialdehyde (MDA) were determined at venous blood before anesthesia (T0), 1 hour after reperfusion (T1) and 3 hours after reperfusion (T2) respectively. Results The levels of plasma ET and MDA in the two groups before operation were significantly higher than those in the normal group (P <0.05). The levels of plasma ET and MDA in both groups were significantly increased at T1 (P <0.05), and at T2 Plasma ET and MDA concentrations were significantly lower than those before 2h (P <0.05), while those in the control group were significantly increased (P <0.05), while those at T1 and T2 were statistically significant (P <0.05 ). Conclusion Selective intracerebral thrombolysis in the treatment of acute cerebral infarction, propofol anesthesia can significantly reduce the concentration of plasma endothelin and malondialdehyde in patients with cerebral ischemia-reperfusion injury may have a protective effect.