氯胺酮和丙泊酚持续颈内静脉输注对脑损伤患者围术期脑保护效应的临床研究.docVIP

氯胺酮和丙泊酚持续颈内静脉输注对脑损伤患者围术期脑保护效应的临床研究 　　[摘要] 目的 探讨氯胺酮和丙泊酚持续颈内静脉输注对脑损伤患者围术期脑保护效应。 方法 选择临床中型脑损伤患者适当病例60例行颅内血肿清除术，随机分三组，各20例。A组：对照组，围术期未特殊处理；B组：围术期氯胺酮/丙泊酚1：1混合0.5 mg/（kg?h）微泵持续颈内静脉输注；C组：围术期氯胺酮/丙泊酚1：1混合1 mg/（kg?h）微泵持续颈内静脉输注。三组患者分别于手术开始前和术毕12、24、48 h不同时间点取对侧颈内静脉血5 mL，采用酶联免疫法（ELISA）测定血清星状细胞胶质蛋白S-100β（S-100β蛋白）和神经元性烯醇化酶（NSE）浓度，并记录不同时间点各组患者神经反射变化和意识恢复情况，6个月后随访60例患者并进行简短精神状态检查（MMSE）。 结果 与A组比较，B、C组随时间延长S-100β蛋白和NSE浓度显著降低，差异有高度统计学意义（P 0.05）。手术结束24 h患者血清S-100β蛋白和NSE浓度越高对应其6个月后随访MMSE评分就越低，血清S-100β蛋白与MMSE评分呈明显负相关（r = -0.618，P 0.05）。 结论 氯胺酮和丙泊酚联合应用对脑损伤围术期有明显的治疗和神经保护作用，术后随访无不良反应或副作用。 　　[关键词] 氯胺酮；丙泊酚；脑损伤；S-100β蛋白；NSE；MMSE 　　[中图分类号] R742.3 [文献标识码] A [文章编号] 1673-7210（2014）02（b）-0085-05 　　Clinical research of Ketamine and Propofol internal carotid vein continuous infusion on brain protective effect in patients with craniocerebral injury during perioperative period 　　LI Qing LUO Xianghong GAO Meiling WANG Xianyu▲ 　　Department of Anesthesiology， Taihe Hospital Affiliated to Hubei Medical University， Hubei Province， Shiyan 442000， China 　　[Abstract] Objective To investigate Ketamine and Propofol internal carotid vein continuous infusion on brain protective effect in patients with craniocerebral injury during perioperative period. Methods Clinical 60 patients with medium craniocerebral injury were randomly divided into 3 groups， with 20 cases in each group. Group A： control group， without any special treatments； group B： mixture of Ketamine and Propofol by 1∶1 were pumped to the carotid vein by a continuous infusion of 0.5 mg/（kg?h） in perioperative； group C： mixture of Ketamine and Propofol by 1∶1 were pumped to the carotid vein by a continuous infusion of 1 mg/（kg?h） in perioperative. 5 mL blood samples were taken at initiation of the surgery， 12 h， 24 h and 48 h after operation from contralateral carotid vein of the three groups. Concentration of both S-100β and NSE in serum of patients was measured by enzyme-linked immunosorbent assay （ELISA）. And reflex changes and recovery