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乌司他丁可减轻全麻颈动脉内膜剥脱术患者的脑缺血/再灌注损伤

DOI: 10.1360/052013-223, PP. 488-494

Keywords: 颈动脉内膜剥脱术,脑缺血/再灌注损伤,乌司他丁,脑保护,麻醉

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Abstract:

本研究拟观察乌司他丁减轻全身麻醉下,行颈动脉内膜剥脱术(CEA)的患者脑缺血再灌注损伤的有效性.将40例有症状的重度颈动脉狭窄,于全身麻醉下行单侧标准颈动脉内膜剥脱术的患者随机分为干预组与非干预组,每组20例.干预组在麻醉诱导前经静脉给予乌司他丁5×105U,非干预组用等量生理盐水.分别于麻醉诱导后、颈动脉夹闭15min、颈动脉开放15min,以及术后第1,2,3天抽取患侧颈内静脉球部血液进行肿瘤坏子因子α(TNF-α)、丙二醛(MDA)检测;分别于麻醉诱导后、颈动脉夹闭15min及开放15min做动脉及颈内静脉球部血气分析;分别于麻醉诱导后及术后第1,2,3天抽取颈内静脉球部血液进行神经元特异性烯醇化酶(NSE)检测.干预组各时间点的TNF-a浓度均低于非干预组(P<0.05),动脉-颈内静脉氧含量差值在颈动脉开放15min时高于非干预组(P<0.05),术后重症监护室驻留时间较非干预组降低38.7%((27.1±15.7)hvs.(44.1±29.6h),P<0.05).两组患者各时间点颈内静脉球部MDA和NSE含量无显著差异(P>0.05).预防性给予乌司他丁能够减轻全麻CEA患者术中脑缺血/再灌注损伤性炎性反应,提高脑氧代谢能力,改善术后转归.

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