The Combined Effects Of Nimodipine And Lumbar Drainage On The Cerebral Oxygen Supply-demand Balance,Energy Metabolism And S100βProtein In Patients With Aneurysm Surgery

Object:To investigate possible cerebral protective effects on the combination of Nimodipine and lumbar drainage in the peroperative period.Methods:Sixty patients with Aneurysm surgery were strictly selected. Patients were divided into three groups:the nimodipine group (n=20), lumbar drainage group (n=20), nimodipine and lumbar drainage group (n=20). Blood from jugular venous bulb and dorsal pedis artery were collected preoperation(TO)、 immediately after the dural sutured(T2)、days1(T3)、3(T4)post operation.Blood gas and the protein S100β level was detemined respectively, indexes of cerebral oxygen supply and demand balance and indexes of metabolism were calculated,finally statistical differences were achieved through comparisons of index levels in serum and their changing trends at time points.Results:1. Sixty patients with CA were finally enrolled, their average age was52±9, forty-five patients were female (56.7%) and fifty-two patients were complicated with hypertension, and parts of these patients had coagulation dysfunction.2. Indexes of cerebral oxygen supply and demand balance of three groups at T1time point were at the same level,and CaO2was normal then CjvO2was lower than the normal, there were differences (major effect P<0.05) when indexes of three groups were compared in pair at T2,T3and T4time point, CaO2, CjvO2and SjvO2were apparently higher in NIM+LD group than those in other two groups, whereas AVDO2and CERO2were apparently lower (P<0.001), there were not significant differences in all indexes when NIM group was compared to LD group. In the comparison of NIM group and LD group, indexes of CaO2, CjvO2and SjvVO2were not different, however, AVDO2and CERO2in NIM group were obviously lower than those in LD group at the T4time point (5.4%VS6.3%P0.05,30.9%VS36.5%P<O.05)。3. Metabolism indexes in three groups were at the same level at T1time point and there were not statistical differences. In the pairwise comparisons of three groups at time points of T2, T3, T4, GluER and LacPR didn’t have significant differences.GluER and LacPR showed descending trends as time passed, these indexes didn’t have significant differences (P>0.05) in the comparisons of NIM+LD group and other two groups although these were little greater in NIM+LD group than those in other two groups, decreasing trends were almost similar in all three groups.4. Protein S100β in three groups were at the same level at T1time point and there were not statistical differences. In the pairwise comparisons of three groups at time points of T2, T3, T4the major effects were all significantly different (P<0.05). Protein S100β expression level showed the ascending trend as time passed, During the process this index was a little less in NIM+LD group than that in other two groups, the ascending trend was smaller in NIM+LD group than that in other two groups(P<0.05). the curves of NIM group and LD group almost coincided with each other during the process.Conclusions:1.when compared to the single use,the combined use of nimodipine and lumbar drainage will improve cerebral oxygen supply and demand balance of patients with cerebral aneurysms hemorrhage received clamp operation.2.when compared to the single use, the combined use of nimodipine and lumbar drainage will not improve cerebral tissue metabolism of patients with cerebral aneurysms hemorrhage received clamp operation.3.when compared to the single use, the combined use of nimodipine and lumbar drainage will decrease serum protein S100β expression level of patients with cerebral aneurysms hemorrhage received clamp operation, resulting in cerebral protection.