Impact On Cerebral Lipid Peroxidation Of0patients Being Controlled Hypotension During Cerebral Operation By Airwise0combination Of Anesthetic Drugs

Object: To study the impact on impairment of cerebral lipid peroxidation among the patients who are implemented controlled hypotension during cerebral operation under the condition of pairwise combination of anesthetic drugs.Methods: Selecting the research object,120 patients with intracranial glioma(confirmed by pathology)undergoing elective craniotomy under general anesthesia.All the patients were randomly divided into 4 groups to implement controlled hypotension(CH): Group remifentanil + sevoflurane(RS),Group remifentanil + propofol(RP),Group sevoflurane + propofol(SP),Group nitroglycerin(N).All of the patients are implemented CH after opening the dura,and the mean arterial pressure(MAP)in each group was decreased by 30% in comparison of preoperative basic value,within the first 10 minutes.After the surgeon closed the dura,the CH was stopped.All patients were continuously monitored for mean arterial pressure(MAP),heart rate(HR)and regional cerebral oxygen saturation(r Sc O2),and recorded respectively at the following five time points:0before inducing general anesthesia(T1),after using scalp retractor fixed scalp(T2),10 minutes after the start of CH(T3),30 minutes after the start of CH(T4),30 minutes after CH was stopped(T5).0At the same time,3 ml of the internal jugular venous blood and radial artery blood were collected into vacuum tube at five time points respectively,then placed them in the refrigerator of-80?to prepare for the detection of superoxide dismutase(SOD)and malondialdehyde(MDA).The bispectral index(BIS)and scores of surgical field quailty(SSFQ)were recorded at the time of T4.Result: In the intra-group comparison of each,the SOD in veins and in arteries at T3,T4 and T5 significantly decreased compared with that at T1(P < 0.05),the difference between that in veins and in arteries showed an upward trend(P<0.05).At the T3,T4,and T5,the SOD of the Group N obviously decreased in comparison of that of Group RP,Group RS,Group SP,0the difference between that in veins and in arteries significantly increased(P < 0.05).0At the T4,the difference of SOD between in veins and in arteries of Group RP significantly increased compared with that of Group RS,Group SP(P < 0.05),but there is no statistical significance of the difference between Group RS and Group SP(P > 0.05).In the intra-group comparison,MDA in artery and in vein,and also the difference between that in vein and in artery showed a significant upward trend(P < 0.05).0At T3,T4 and T5,the MDA of Group N in vein,and also the difference between that in vein and in artery both increased significantly in comparison of that of Group RP,Group RS and Group SP(P < 0.05).0At T4,the MDA of Group RP in vein and the difference between that in vein and in artery increased significantly in comparison of that of Group RS and Group SP(P < 0.05).But there is no statistical significance of the difference between Group RS and Group SP(P > 0.05).0The r Sc O2 of each group at T3 and T4 decreased significantly in comparison of T1,T2 and T5(P < 0.05).0There is no statistical significance of the differences compared between each group(P > 0.05).The BIS of Group SP decreased significantly in comparison of Group RP and Group RS(P < 0.05).However that of Group N increased significantly(P < 0.05).Meanwhile,the SSFQ score of Group N raising obviously compared with that of the other three groups(P < 0.05).Conclusion: Using 3 kinds of anesthetic drugs,remifentanil,sevoflurane and propofol,to implement CH under the condition of pairwise combination in cerebral operation,is not only able to reduce the hemorrhage to meet the need of the operation under the premise of ensuring the afety of patients,but also can reduce MDA,increase SOD in brain tissue and protect brain in comparison of using the nitroglycerin.The degree of lipid peroxidation injury is more obvious reduction,and does not increase the depth of anesthesia in the programme of remifentanil combined with sevoflurane,which is a safety and reliable programme that can be implemented in clinical cerebral operation,compared with that of the two programmes,propofol combined with remifentanil or sevoflurane.