| ObjectivePatients with intracranial tumors is often accompanied by high intracranial pressure, and intraoperative hypotension, humoral imbalance and coagulation surgical operation, surgical instruments, such as iatrogenic factors, can cause or worsen hypoxic-ischemic brain injury, brain tissue oxygen supply and demand imbalances and barriers to energy metabolism, hypoxic-ischemic brain injury and cell Ca2+ overload, excitotoxic amino acid toxicity, free radical generation, such as the release of inflammatory mediators. Intraoperative brain to take appropriate protective measures is crucial for patients with postoperative recovery.Brain protection at home and abroad for studies have shown that mild hypothermia, such as intravenous and inhaled anesthetics, there is a certain degree of cerebral protection, but there are still intraoperative cerebral oxygen supply and demand imbalances, and of the intracranial tumor resection in the application of intravenous, inhalation anesthetic, such as to improve the postoperative prognosis of the effectiveness and shorten the course, there are as yet no information on a large sample to be confirmed. It is therefore necessary to study in the use of intravenous or inhalation anesthesia under the premise of general anesthesia, the joint use of cerebral protection other drugs, the possibility of further strengthening the brain protective effect, the exact prognosis to improve and shorten the course of disease and reduce complications.Nimodipine, a selective and L-Ca2+-type channel with the main regulator of intracellular Ca2+ levels to maintain normal physiological functions, there are more fat-soluble, easily through the blood-brain barrier, can be selective the expansion of cerebral blood vessels, reduce the brain edema, brain tissue of hypoxic-ischemic protective effect. Selective expansion of blood vessels rather than produce a "steal" phenomenon, in the increase in cerebral blood flow at the same time, almost does not affect cerebral metabolism. Its mechanism is specific inhibition of membrane Ca2+ channels open, to reduce the Ca2+ influx; On the other hand strengthen the mitochondria, endoplasmic reticulum calcium stores, such as uptake and storage of the role of Ca2+.Ligustrazine is one major efficient component form the Chine Traditional Medicine herb Chuanxiong, clinically acute ischemic cerebrovascular disease have a certain effect. Ligustrazine can reduce the large cerebral ischemia in mice, hypoxic injury, reduce lipid peroxidation and the release of inflammatory mediators. That its mechanism of Ligustrazine ischemic brain tissue to improve microcirculation, increase blood volume of brain tissue to reduce the brain ischemia, hypoxia-induced injury.Screen on the drugs used in tumor patients in the perioperative period is a clear protective effect of the brain, the joint application of the existence of synergies, and the balance of cerebral oxygen supply and demand and the impact of energy metabolism has not been reported. At present, evaluation of hypoxic-ischemic brain injury indicators including monitoring cerebral oxygen supply-demand balance and energy metabolism, detection of superoxide dismutase (SOD), malondialdehyde (MDA), S100βprotein and neuron-specific enolase (NSE) and so on. Monitoring cerebral oxygen supply and demand balance and energy metabolism in brain tissue reflects not only the oxygen uptake and utilization, but also indirectly reflects the cerebral blood flow and intracranial pressure changes; detection of SOD, MDA in brain tissue reflect the level of oxygen free radicals and the extent of lipid peroxidation; detection of S100βprotein and NSE on behalf of the extent of neuronal damage.Observation in this study therefore Propofol total intravenous anesthesia, nimodipine, Ligustrazine single or combination of supratentorial tumors in patients with perioperative serum S100βprotein, NSE, SOD activity and MDA content and cerebral oxygen supply and demand balance and energy metabolism in order to explore a single or a combination of two drugs in such surgery perioperative brain protection.Methods1 General Information screen of selective tumor 48 cases of patients, ASAâ… -â…¡grade, were diagnosed as meningioma. Randomly divided into control group (A group) and the nimodipine group (N group), Ligustrazine group (C) group, Ligustrazine Unite Nimodipine group (NC group) 12 cases each. Preoperative electrocardiogram, blood, blood and liver and kidney function and biochemical examinations are reactive, such as within the normal range, patients with no history of diabetes and epilepsy Britain, Glasgow score 15 points. 2 Anesthesia the use of propofol and remifentanil anesthesia compound. N group in the beginning of anesthesia with nimodipine infusion micropump 15μg ? kg-1 ? h-1, the end of the drug operation. Group C will be entered into 0.9% normal saline 250 mL by adding 80mg Ligustrazin, when the cut dural venous input 20min. NC group after induction of anesthesia with the application of nimodipine Ligustrazin, methods with the N group and C group. A group at the same time the importation of normal saline.3 specimens collected Blood samples were taken from artery and jugular venous bulb imultaneously before induction of anesthesia (T1,baseline ), at intubation (T2 ), open dura instantly (T3), open dura after 1h (T4), at the closure of dura (T5), and 24h after operation (T6), for blood gas analysis and blood glucose montitoring and the result were recorded, and 5ml blood samples taken to test-tube centrifuge question.4 Detection indicator Content of artery blood oxygen (CaO2), Saturation of internal jugular venous bulb blood oxygen (SjvO2), Content of internal jugular venous bulb blood oxygen (CjvO2), Content of artery-internal differences in oxygen(Ca-jvO2) and Cerebral extraction ratio oxygen (CERO2); Glucose extraction ratio (GluER), Cerebral lactate acid production rate (LacPR), Lactate oxygen index (LOI); Concentration of internal jugular venous bulb serum S100βprotein, Concentration of internal jugular venous bulb serum Neuron-specific enolase (NSE), Activity of internal jugular venous bulb serum Superoxdie dismutase (SOD), Content of internal jugular venous bulb serum Malondialdehyde (MDA), Content of Lactic Acid (LD).5 Statistical analysis using SPSS 13.0 statistical analysis software, data mean±standard deviation ((?)±s) that the measurement data using repeated measure analysis of variance, the application of LSD multiple comparison method, the de facto inter-group comparison with two independent samples t test or one-way ANOVA, four groups of patients take the basic information one-way ANOVA, P≤0.05 for the difference statistically significant.Results1. four groups of patients, compared to the situationEach group of patients with age, weight, anesthesia time, propofol and remifentanil dosage, infusion volume was no significant difference (P = 0.415, P = 0.776, P = 0.921, P = 0.938, P = 0.949, P = 0.790).2. indicators of cerebral oxygen supply-demand balance2.1 CaO2There was significant difference between intra-group comparisons (F = 68.199, P = 0.000). A group in which T2 significantly higher than the T1 time point (P <0.017); and each group T3, T4, T5, T6 than the T1 time point significantly lower (P <0.004).between the each group difference time point no significant difference (F = 0.444, P = 0.723).2.2 CjvO2There was significant difference between intra-group comparisons (F= 100.018, P = 0.000). T2 in which the group significantly higher than the T1 time point (P <0.02); A, C group of T3, T4, T5, T6 than the T1 time point significantly lower (P <0.001); N groups T4, T5, T6 than T1 point significantly lower (P <0.007); NC group T4, T6 than the T1 time point significantly lower (P <0.019).Between group comparison of each time point, N group of T6 is significantly higher than A group (P = 0.018); NC group T3, T4, T5, T6 is significantly higher than A group (P = 0.000 - 0.039 ); NC group T5 is significantly higher than N group (P = 0.024 ); NC group T5, T6 is significantly higher than C group(P = 0.002 - 0.007). The remaining point there was no statistical significance. 2.3 SjvO2 There was significant difference between intra-group comparisons (F = 49.829, P = 0.000). T2 in which the group significantly higher than the T1 time point (P <0.005); A, N, C group T6 than the T1 time point significantly lower (P <0.046).Between group comparison of each time point, N group of T6 is significantly higher than A group (P = 0.002), NC group T3, T4, T5, T6 is significantly higher than A group (P = 0.000 - 0.038), NC Group T6 is significantly higher than N group (P = 0.033), NC group T5, T6 is significantly higher than C group (P = 0.003 - 0.004). The remaining point there was no statistical significance.2.4 Ca-jvO2There was significant difference between intra-group comparisons (F = 17.115, P = 0.000). T2 in which the group significantly lower than the T1 time point (P <0.011); N Group T6 significantly higher than the T1 time point (P<0.030); C Group T5, T6 significantly higher than the T1 time point (P <0.031); NC group T3, T4, T5, T6 significantly higher than the T1 time point (P <0.015). The remaining point there was no statistical significance.Between group comparison of each time point, N group T6 significantly lower than the A, C group (P = 0.015 - 0.016); NC group T3, T4, T5, T6 significantly lower than A group (P - 0.021-0.048); NC group T5, T6 significantly lower than the C group (P = 0.021 - 0.031). The remaining point there was no statistical significance.2.5 CERO2There was significant difference between intra-group comparisons (F = 23.203, P = 0.000). T2 in which the group significantly lower than the T1 time point (P <0.009); A group T6 significantly higher than the T1 time point (P <0.019); C Group T6 significantly higher than the T1 time point (P <0.046).Between group comparison of each time point, N group T6 significantly lower than the A, C group (P = 0.001- 0.009), NC group T3, T4, T5, T6 significantly lower than A group (P = 0.001 - 0.015), NC group T3, T5, T6 significantly lower than the C group (P = 0.004 - 0.031). The remaining point there was no statistical significance.3 brain energy metabolism3.1 GluERThere was no statistically difference each intra-group comparisons and between the each groups (F= 0.859, P = 0.517; F= 0.616, P = 0.580).3.2 LacPRThere was significant difference between intra-group comparisons (F = 520.086, P = 0.000), T2, T3, T4, T5, T6 time point significantly lower than the T1 time point (P <0.010).each group no significant difference (F=0.353,P = 0.787).3.3 LOIThere was significant difference between intra-group comparisons (F = 209.329, P = 0.000), T2, T3, T4, T5, T6 time point significantly lower than the T1 time point (P <0.010).each group the difference was not significant (F = 0.668, P = 0.526).4 Activity of internal jugular vein bulb serum SODThere was significant difference between intra-group comparisons (F = 13.651, P = 0.000). In which A, N group of T3, T4, T5, T6 significantly lower than the T1 time point ( P <0.022 ); C group of T3, T4, T5 significantly lower than the T1 time point (P <0.022); NC group T5 significantly lower than the T1 time point (P<0.047).Between group comparison of each time point, N group T3, T4, T5, T6 significantly higher than A group (P = 0.001 - 0.028); C Group T4, T5, T6 is significantly higher than A group (P = 0.022 - 0.028); NC group T3, T4, T5, T6 is significantly higher than A group (P = 0.000 - 0.004), NC group T3, T5 is significantly higher than C group (P = 0.024 - 0.040). The remaining point there was no statistical significance.5 Content internal jugular vein bulb serum MDAThere was significant difference between intra-group comparisons (F = 17.054, P = 0.000). In which N, C, NC Group of T4, T5, T6 time point significantly lower than the T1 time point (P<0.010).Between group comparison of each time point, N group of T3, T4, T5, T6 significantly lower than A group (P = 0.007 - 0.038); C Group T4, T5, T6 significantly lower than A group (P = 0.013 - 0.036); NC group T3, T4, T5, T6 significantly lower than A group (P = 0.002 - 0.044). The remaining point there was no statistical significance.6 Concentration of internal jugular vein bulb serum S100βThere was significant difference between intra-group comparisons (F =38.852, P = 0.000), in which A group of T3, T4, T5, T6 significantly higher than the T1 time point (P <0.001); N Group T2, T3 significantly higher than the T1 time point (P <0.025); C group T2, T3 , T4, T5,T6significantly higher than the T1 time point (P <0.005); NC group T2, T3, T4 significantly higher than T1 (P <0.012).Between group comparison of each time point, N group T3 , T4, T5, T6 significantly lower than A group (P = 0.000 - 0.003), C group T4, T5, T6 significantly lower than the A group (P <0.001); NC group T3, T4, T5, T6 significantly lower than A group (P <0.001); N group T3 significantly lower than the C group (P <0.001); NC group T3, T4, T5, T6 significantly lower than the C group (P = 0.000 -0.006). The remaining point there was no statistical significance.7 Concentrations of internal jugular vein bulb serum NSEThere was significant difference between intra-group comparisons (F = 59.510, P = 0.000), in which A group of T2, T3, T4, T5, T6 significantly higher than the T1 time point (P <0.025); N Group T2, T4 significantly higher than the T1 time point (P <0.014); C group T3, T4, T5, T6 significantly higher than the T1 time point (P<0.015); NC groupT4 significantly higher than T1 (P <0.016); N, NC groupT6 significantly lower than T1 (P <0.029).Between group comparison of each time point, N group of T3 , T4, T5, T6 significantly lower than A group (P = 0.000 - 0.035), C group T4, T5, T6 significantly lower than A group (P <0.001); NC group T3, T4, T5, T6 significantly lower than the A group (P <0.007); N group T3, T6 significantly lower the C group (P = 0.009 -0.023); NC group of T3, T4, T5, T6 the C group (P = 0.001 - 0.032). The remaining point there was no statistical significance.Conclusion1 In total intravenous propofol anesthesia for supratentorial tumor resection in patients with postoperative cerebral oxygen supply and demand imbalance exists; energy metabolism changes, but within the normal range; oxygen free radicals increase in nerve cell injury aggravated; in postoperative 24h during the more serious.2 In total intravenous propofol anesthesia infusion of nimodipine can not improve the supratentorial tumor surgery in cerebral oxygen supply and demand imbalance, but can improve within 24h after operation due to the imbalance between cerebral oxygen supply and demand; no effect on the energy metabolism; and to increase in patients, within 24h after serum SOD activity and lower MDA content and serum S100β, NSE concentration.3 In the propofol infusion under total intravenous anesthesia can not be corrected Ligustrazin supratentorial tumor surgery, after 24h in patients with cerebral oxygen supply and demand imbalance and does not affect the energy metabolism; but can increase serum SOD activity and lower MDA content and serum S100β, NSE concentration.4 In total intravenous propofol anesthesia combined nimodipine infusion ligustrazine screen can be corrected during tumor resection, postoperative cerebral oxygen supply and demand balance; but does not affect energy metabolism. Significantly increase the serum SOD activity and lower MDA content and serum S100β, NSE concentrations, especially within 24h after a more visible effect.5 In total intravenous propofol anesthesia, the application of nimodipine, ligustrazine, during and after 24h of energy metabolism do not affect the internal situation, by blocking intracellular Ca2+ overload, scavenging oxygen free radicals, inhibit lipid peroxidation quality, reduce neuronal damage, to a certain extent the role of cerebral protection, the two drugs in combination for the protective effect of brain surgery more prominent. |
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