目的:探讨异丙酚联合瑞芬太尼对急性颅脑外伤手术患者髓鞘碱性蛋白(myelin basic protein,MBP)、神经元特异性烯醇化酶(neuron-specific enolase,NSE)及S100B蛋白、D-二聚体(D-Dimer,D-D)及炎性因子水平的影响。方法:选择我院收治的100例需进行急诊手术的颅脑外伤患者,随机分为对照组和实验组,各50例。对照组给予异氟醚联合瑞芬太尼维持麻醉,实验组给予异丙酚联合瑞芬太尼维持麻醉。检测并比较两组麻醉前(T₀)、手术中1 h(T₁)及手术后1 h(T₂)的炎性因子及MBP、NSE、S100B蛋白及D-D水平。结果:两组组内及组间的TNF-α水平比较差异均无统计学意义(P>0.05)。两组血清hs-CRP水平T₁、T₂时明显上升,相比T₀时差异均有统计学意义(P<0.05),实验组T₁、T₂时血清hs-CRP水平明显高于对照组,差异具有统计学意义(P<0.05)。两组MBP、NSE、S100B蛋白及D-D水平T₁、T₂时明显上升,相比T₀时差异均有统计学意义(P<0.05),实验组T₁、T₂时MBP、NSE、S100B蛋白及D-D水平均明显低于对照组,差异具有统计学意义(P<0.05)。结论:异丙酚联合瑞芬太尼用于急性颅脑外伤手术的麻醉,能够维持围手术期炎性细胞因子水平的平衡,抑制血清MBP、NSE、S100B蛋白、D-D水平的升高,减轻脑细胞损伤,具有良好的脑细胞保护作用,值得在临床上推广应用。

Objective: To investigate the effects of Propofol combined with remifentanil on serum levels of MBP, NSE and S100B protein, D-D and inflammatory factors in patients with acute craniocerebral trauma. Methods: We selected 100 patients with traumatic brain injury who underwent emergency surgery from August 2014 to May 2017 in our hospital,then randomly divided them into the control group and the experimental group, 50 cases each.The control group received isoflurane combined with remifentanil to maintain anesthesia, and the experimental group received propofol and remifentanil to maintain anesthesia.The inflammatory factors and the levels of MBP, NSE, S100B and D-D in the two groups before and after anesthesia (T₀), 1H (T₁) and postoperative 1H (T₂) were detected and compared. Results:There was no significant difference between the two groups in the levels of TNF-α (P>0.05).The serum level of hs-CRP in two groups of T₁, T₂ increased significantly, the difference was statistically significant compared with T0 (P<0.05), in the experimental group, serum level of hs-CRP at T₁ and T₂ was significantly higher than the control group, the difference was statistically significant (P<0.05). Conclusion: Propofol combined with remifentanil anesthesia for acute craniocerebral trauma can maintain the balance of inflammatory cytokine levels during the perioperative period, inhibit the elevation of serum MBP, NSE, S100B protein and D-D levels,reduce brain cell damage.It has a good protective effect on brain cells and is worthy of clinical application.

R651.1+5

陕西省自然科学基金(2016JQ2341)