Study On Cerebral Protection Of Astragalus Mongholicus Injection In Patients With Supratentorial Tumor During Propofol Total Intravenous Anesthesia

ObjectiveOften in patients with brain tumors increased intracranial pressure, cerebral tissue hypoxia, edema, necrosis, etc., pathophysiological changes, surgery, burning, electrocoagulation, attracting for attracting brain plate oppression, it is difficult to avoid distraction, and other operating and caused lesions brain tissue around the mechanical and hypoxic-ischemic injury. Neurosurgery long time, extent of the damage to nerve cells or brain tissue metabolism. Therefore, the protection of brain nerve surgery is an important component.Propofol is widely used intravenous anesthetics through the cytochrome P450 system and the role of glucose Gansuan large metabolism in the liver. Research has confirmed that its anti-oxidation and removal of oxygen free radicals, may reduce cerebral blood flow and cerebral metabolic rate of oxygen, reducing intracranial pressure, there is a certain degree of cerebral protection. Propofol cerebral protection attributed to its antioxidant properties and enhance A-y-amino acid (GABA)-mediated inhibition of synaptic transmission and the role of the inhibition of glutamate release. However, in clinical studies, no propofol changes in the nerve better than other anesthetics evidence.Astragalus (Astragale) is a Chinese medicine treatment of ischemic cerebrovascular disease commonly used drugs, modern pharmacological research has confirmed that the improvement of microcirculation and anti-free radicals and antioxidant effects. In recent years found that Astragalus hypoxic ischemic brain injury in animal models of the effects of cerebral protection more significant. Research confirmed that Astragalus on oxygen free radical-induced damage in rat brain mitochondria significantly protective effect, the mechanism of membrane phospholipids is inhibited degradation, mitochondrial swelling, change mitochondrial energy metabolism and enhance antioxidant capacity. Astragalus can also affect the function of NMDA receptors, rapid inhibition of glutamate-induced Ca²⁺ concentration increased the hippocampus, the hippocampus has a protective effect. Experiments show that, astragalus can inhibit brain ischemia reperfusion edema secondary to remove damaged brain tissue oxygen free radicals blocking brain lipid peroxidation, improving energy metabolism.This study on the screen in the serum of patients with tumor resection S100βprotein, NSE, SOD, MDA and cerebral oxygen supply and demand balance in order to assess whether the astragalus injection supratentorial tumor resection of patients with brain protection.Methods1. Select ASAâ… -â…¡supratentorial tumors in patients with elective surgery, pathological diagnosis of meningioma patients without a history of diabetes.2. Experimental groups: Choose standard 24 patients were randomly divided into H (Astragalus) and S (NS) group (n = 12).3. Income to the operating room under local anesthesia after the left common carotid vein retrograde catheterization (deep sigmoid sinus), the dorsalis pedis artery puncture, conventional induction of anesthesia, anesthesia was maintained. Group H was immediately cut dural application astragalus injection, in addition to not astragalus injection S group, the other Group H and the same. Not in the application of inhalation anesthetics, transfusion of more than four units removed cases, no application for containing lactic acid, liquid sugar, in order to avoid the impact of the experiment.4. Respectively before general anesthesia induced by intubation immediate, open dural instantly, transfusion after 1h, 24h after infusion five times synchronous acquisition of the internal jugular vein and the ball dorsalis pedis artery for blood gas analysis, blood glucose monitoring , and 5 ml blood samples from the test tube to be centrifugal.5. Specimens 3000 to / from heart 15 minutes, the supernatant from pipettes, frozen in -80℃to avoid repeated freezing and thawing.6. Detection: Serum S100βprotein, NSE concentration determination by ELISA, serum SOD, MDA were measured using visible light.Results1. Two groups of patients by gender, age, body weight, anesthesia time, propofol and remifentanil dosage and the infusion of no significant difference (P> 0.05).2. Two groups of patients with Saturation of internal jugular venous bulb blood oxygen (SjvO₂) T₂ were significantly higher than T₁ F = 9.334, P = 0.001 (P <0.05) between the two groups at different time points SjvO₂ no significant differences F = 0.465, P = 0.502 (P> 0.05).3. Two groups of patients with Content of internal jugular venous bulb blood oxygen (CjvO₂) T₃, T₄, T₅ significantly lower than T₁ ; at each time point between the two groups CjvO₂ no significant difference (F = 2.702, P = 0.114);4. Two groups of patients with Cerebral extraction ratio oxygen (CERO₂) T₂3 significantly lower than T₁ F = 5.131, P = 0.006 (P <0.05) between the two groups at different time points CERO₂ no significant difference (F = 0.406, P = 0.530) (P > 0.05).5. Two groups of patients with Glucose extraction ratio (GluER) no significant difference (F - 1.392, P = 0.274) ; between the two groups at different time points GluER no significant difference (F= 0.406, P = 0.530).6. Two groups of patients with Cerebral lactate acid production rate (LacPR), Lactate oxygen index (LOI) T₂, T₃, T₄, T₅ were significantly lower than T₁ ; LacPR, LOI were no significant differences between the two groups at each time point F - 0.306, P -0.586 and F= 9.299, P = 0.6067. Two groups of patients with superoxide dismutase (SOD) activity T₃, T₄, T₅ were a significant reduction than T₁ (F = 15.369, P = 0.000) (P <0.05), of which H group SOD activity was significantly higher than that in group S (F =6.967, P =0.015).8. Two groups of patients with malondialdehyde (MDA) in T4, T5 with a significantly increased than T₁ (F=35.764, P=0.000), of which the content of MDA Group H was significantly lower than that in group S (F=4.853, P=0.038).9. Two T₃, T₄, T₅ Serum S100βprotein concentration (S100β) than T₁ has significantly increased (F=64.540, P=0.000), of which T₄, T₅ Serum S100βprotein concentration of H group was significantly lower than S (F=5.633, P=0.027).10.Two T₃, T₄, T₅ serum neuron-specific enolase concentrations (NSE) have asignificantly increased T₁ (F=34.328, P=0.000), of which T₄, T₅ serum concentrationsof NSE Group H was significantly lower than that in group S (F=4.444, P=0.047).Conclusion(1)There was no significantly influence on cerebral oxygen of supply-consumptionand energy metabolism using astragale in patients with supratentorial tumor.(2)There were significantly influence on SOD and MDA during operation,and astragale could increase SOD and inhibit MDA.(3)There were significantly increasing on S100βand NSE during operation,andastragale could significantly reducing the concentration of S100βand NSE in bloodserum..