Effect On Cerebral Lipid Peroxidation Injury Of Different Range Of Controlled Hypotension In Patients With Cerebral Operation

Object:To discuss the effect of remifentanil combined with sevofluraneby different controlled hypotension range on the cerebral lipid peroxidation in patients with glioma.Methods:90 patients with intracranial glioma,undergoing the elective craniotomy under general anesthesia from October 2015 to August 2017,were divided into three groups by random number table method:remifentanil+sevoflurane controlled hypertension group[RS1,mean arterial pressure?MAP?compared with the basic value decrease of 15-20%],RS2 group?MAP compared with the basic value decreased 21-25%?,RS3 group?MAP was decreased 26-30%?,30 cases in each group.Mean arterial pressure?MAP?,heart rate?HR?and regional cerebral oxygen saturation?rScO₂?are recorded at the following five time points:before inducing general anesthesia?T1?,after using scalp retractor fixed scalp?T2?,10 minutes after the start of controlled hypotension?T3?,30 minutes after the start of controlled hypotension?T4?,30 minutes after stopping controlled hypotension?T5?.Bispectral index?BIS?and field quality score?SSFQ?are also need to be recorded at T4.The internal jugular venous blood 3ml and radial artery blood 3ml are collected into vacuum tube at five time points respectively,then placed them in the refrigerator of-80?to prepare the detection for superoxide dismutase activity?SOD?and malondialdehyde content?MDA?.Result:In intra-group comparison,at the time of T3,T4,T5,the SOD activity of artery and vein blood of the three groups of patients were lower than that of T1?P<0.05?,however,the difference between the vein-artery shows an increasing trend?P<0.05?.In T3,T4 and T5,the MDA content in the arteries and veins of the three groups was significantly higher than that in T1?P<0.05?,moreover,the difference between the vein-artery shows an increasing trend?P<0.05?.Comparison between groups,in T4 and T5,the difference between the vein-artery activity of SOD of RS2 group compared with RS1 and RS3 group was significantly decreased?P<0.05?,while the difference between the vein-artery activity of SOD of RS1group and RS3 group were not statistically significant?P>0.05?;compared with RS1group,BIS of RS3 was significantly lower?P<0.05?;SSFQ scores of the three groups were not statistically significant?P>0.05?.Conclusion:The use of remifentanil combined with sevoflurane in patients with glioma in controlled hypotension,compared with RS1 group and RS3 group,when MAP was lower than baseline value by21-25%,it not only can increase the activity of SOD to the greatest extent,but also can reduce the content of MDA,so that the cerebral lipid peroxidation damage of the brain tissue minimized,and it is a safe and effective controlled hypotension range.