川芎嗪、尼莫地平单一或联合应用对幕上肿瘤切除术患者血清S100β蛋白、NSE的影响

摘要

目的 探讨川芎嗪、尼莫地平单一或联合应用对幕上肿瘤切除术患者围术期颈内静脉球部血清S100β蛋白(S100β)与神经原特异性烯醇化酶(NSE)的影响.方法 择期行幕上肿瘤切除术患者48例,随机均分为川芎嗪组(C组)、尼莫地平组(N组)、川芎嗪联合尼莫地平组(CN组)和对照组(D组).C组将80 mg盐酸川芎嗪加入生理盐水250ml中,于切开硬脑膜时20 min内静脉输入；N组在麻醉开始时输注尼莫地平15μg·kg-1·h-1,于手术结束时停药；CN组应用川芎嗪与尼莫地平,方法同C组与N组；D组在与CN组同一给药时点输入等量生理盐水.分别于全麻诱导前(T1)、气管插管即刻(T2)、切开硬脑膜即刻(T3)、切硬脑膜后1 h(T4)、缝硬脑膜时(T5)、术后24 h(T6)采集颈内静脉球部血测定血清S100β、NSE浓度.结果 D组与C组T3～T6时S100β与NSE高于T1时(P＜0.05).而N组与CN组T3、T4时S100β与NSE高于T1时(P＜0.05).C组、N组与CN组T4～T6时S100β与NSE均低于D组(P＜0.05),CN组T3～T6时S100β与NSE均低于C组(P＜0.05),N组T3时S100β、NSE及T6时NSE均低于C组(P＜0.05).结论 幕上肿瘤切除术中单独输注川芎嗪或尼莫地平可降低颈内静脉球部中脑损伤指标浓度,且尼莫地平优于川芎嗪,联合用药脑保护作用强于单一用药.%Objective To evaluate the effects of intraoperative ligustrazine and nimodipine infusion on serum S100β protein and neuron-specific enolase (NSE) content in patients during supratentorial tumor resection. Methods Forty-eight ASA Ⅰor Ⅱ degree patients, aged 18-65 years old. undergoing supratentorial tumor resection were randomly divided into ligustrazine group (group C), nimodipine group (group N), ligustrazine combined nimodipine group (group CN) and control group (group D). Group C received 0. 9% sodium chloride 250 ml added by ligustrazin 80 mg when the dural open. Group N was infused nimodipine 15 μg·kg-1 ·h-1at beginning of anesthesia. Group CN was infused nimodipine and ligustrazin with the method of the group N and group C. while group D was given the same amount of 0. 9% sodium chloride. Wood samples were taken from artery and jugular venous bulb simultaneously before induction of anesthesia (T1), intubation (T2). open dura instantly (T3). 1 h after the dura open (T4), at the closure of dura (T5). and 24 h after operation (T6), serum Sl00β protein and NSE were analysed. Results The serum concentration of S100β and NSE in group D and C at T3-T6 increased significantly compared with T, (P<0.05). The serum Sl00β and NSE in group N and CN was higher at T3-T4 than at T, (P<0.05). At T4-T6. the serum concentration of Sl00β and NSE was lower in group C.N.CN than in group D(P<0. 05). At T3-T6. the concentration of SI 00(3 and NSE was lower in group CN than in group C(P<0. 05). At T3 and T6,the concentration of SI00β and NSE was lower in group N than in group C (P<0. 05). Conclusion Ligustrazin and nimodipine can decrease the concentration of serum Sl00β and NSE in patients during supratentorial tumor resection, Nimodipine could be better than ligustrazin. the effect maybe stronger while they were combined