【摘要】： 背景 腦膜瘤是臨床上的常見病,約占臨床上腦腫瘤15%,其組織病理大多為良性表現(xiàn),具有生長緩慢侵襲性較小的特點(diǎn)。雖然有多種方法可以用于腦膜瘤的治療,但手術(shù)切除腦膜瘤是唯一有效的方法,臨床上手術(shù)切除腫瘤時(shí)硬腦膜切開導(dǎo)致的腦組織腫脹和腫瘤切除減壓可導(dǎo)致腦組織缺血再灌注損傷,嚴(yán)重影響患者的預(yù)后和生命安全。雖然已有實(shí)驗(yàn)證實(shí)缺血預(yù)處理具有減輕腦缺血再灌注損傷的作用,但是其臨床應(yīng)用的不可操作性和創(chuàng)傷性限制了其臨床應(yīng)用。非缺血預(yù)處理的方法中已經(jīng)證實(shí)高壓氧,電針和吸入麻醉劑等預(yù)處理方法可以減輕缺血再灌注損傷,但在臨床應(yīng)用中具有一定的局限性。許多動(dòng)物實(shí)驗(yàn)研究已證實(shí)遠(yuǎn)程缺血預(yù)處理具有減輕心、腦、肝、腎、脊髓等器官的缺血再灌注損傷作用。最近一系列臨床隨機(jī)對照試驗(yàn)研究也證實(shí),遠(yuǎn)程缺血預(yù)處理可減輕心血管手術(shù)時(shí)心肌的缺血再灌注損傷。這對我們預(yù)防腦膜瘤切除手術(shù)后產(chǎn)生的腦缺血再灌注損傷提供了新的思路。由于遠(yuǎn)程缺血預(yù)處理具有方便安全、無創(chuàng)傷且臨床操作簡便易行等優(yōu)點(diǎn)。設(shè)計(jì)本研究旨在探討遠(yuǎn)程缺血預(yù)處理對腦膜瘤切除術(shù)后腦缺血再灌注損傷的保護(hù)作用,為將來其大規(guī)模臨床應(yīng)用提供科學(xué)依據(jù)。 目的 通過對圍術(shù)期腦組織損傷具有特異性的生化指標(biāo)的觀察和神經(jīng)功能評分,探討遠(yuǎn)程缺血預(yù)處理對腦膜瘤切除術(shù)后腦缺血再灌注損傷的保護(hù)作用。 方法 56例擇期行腦膜瘤切除術(shù)的腦膜瘤患者在麻醉誘導(dǎo)前隨機(jī)分成兩組:遠(yuǎn)程缺血預(yù)處理組26例和對照組30例。遠(yuǎn)程缺血預(yù)處理參照文獻(xiàn)使用充氣式止血帶對右上肢實(shí)施3次5分鐘缺血5分鐘再灌注,充氣壓力為200mmHg。對照組只放置止血帶,不進(jìn)行充氣。兩組患者均行L4—5穿刺置管抽取腦脊液。分別于麻醉誘導(dǎo)前、誘導(dǎo)后預(yù)處理前、硬腦膜切開前、硬腦膜切開后4小時(shí),24小時(shí),3天和7天采集血液標(biāo)本檢測血清S-100B和神經(jīng)元特異性烯醇化酶(NSE)的濃度,檢測誘導(dǎo)后預(yù)處理前、硬腦膜切開前及硬腦膜切開后4小時(shí)和24小時(shí)的腦脊液S-100B和神經(jīng)元特異性烯醇化酶(NSE)的濃度。并于術(shù)前及術(shù)后2天和術(shù)后7天對患者神經(jīng)功能學(xué)進(jìn)行評分。 結(jié)果 1.對血清生化指標(biāo)的影響。生化指標(biāo)檢測表明預(yù)處理組血清NSE水平在硬腦膜切開后4和24小時(shí)與對照組相比較明顯降低(P0.05)。 2.對腦脊液血清生化指標(biāo)的影響。腦脊液中預(yù)處理組硬腦膜切開后4小時(shí)和24小時(shí)NSE和S100B的濃度與對照阻閉較均明顯降低(P0.05)。 3.預(yù)處理組的神經(jīng)功能學(xué)評分在術(shù)后2天和7天均好于對照組。 結(jié)論 本研究結(jié)果證實(shí),遠(yuǎn)程缺血預(yù)處理對腦膜瘤切除術(shù)后腦缺血再灌注損傷具有保護(hù)作用,可以改善患者的預(yù)后提高術(shù)后生活質(zhì)量。這項(xiàng)新的研究結(jié)果為將來遠(yuǎn)程缺血預(yù)處理在臨床腦膜瘤切除術(shù)中的應(yīng)用提供理論和臨床依據(jù)。
[Abstract]:Background meningioma is a common clinical disease, accounting for about 15% of clinical brain tumors. Most of its histology is benign and has the characteristics of slow growth and small invasiveness. Although there are many methods that can be used in the treatment of meningioma, surgical resection of meningioma is the only effective method. The swelling of brain tissue caused by dural incision and decompression during surgical resection of tumor can lead to cerebral ischemia-reperfusion injury, which seriously affects the prognosis and life safety of patients. Although ischemic pretreatment has been proved to be effective in reducing cerebral ischemia-reperfusion injury, its clinical application is inoperable and traumatic, which limits its clinical application. It has been proved that hyperbaric oxygen, electro-acupuncture and inhaled anesthetics can reduce ischemia-reperfusion injury in non-ischemic pretreatment, but it has some limitations in clinical application. Many animal experiments have confirmed that remote ischemic pretreatment can alleviate ischemia-reperfusion injury in heart, brain, liver, kidney, spinal cord and other organs. A series of recent clinical randomized controlled trials have also confirmed that remote ischemic pretreatment can reduce myocardial ischemia-reperfusion injury during cardiovascular surgery. This provides a new way for us to prevent cerebral ischemia-reperfusion injury after meningioma resection. Remote ischemic pretreatment has the advantages of convenience, safety, non-trauma and simple clinical operation. The purpose of this study was to investigate the protective effect of remote ischemic preprocessing on cerebral ischemia-reperfusion injury after meningioma resection, and to provide scientific basis for its large-scale clinical application in the future. Objective to investigate the protective effect of remote ischemic pretreatment on cerebral ischemia-reperfusion injury after meningioma resection by observing the specific biochemical indexes and neurological function score of perioperative brain tissue injury. Methods 56 patients with meningioma undergoing elective meningioma resection were randomly divided into two groups: remote ischemic pretreatment group (n = 26) and control group (n = 30). The right upper limb was treated with inflatable tourniquet for 3 times for 5 minutes, ischemia for 5 minutes and reperfusion for 5 minutes, and the inflatable pressure was 200 mm / kg 路L ~ (- 1) 路L ~ (- 1). The control group only placed tourniquet, not inflated. Cerebrospinal fluid (cerebrospinal fluid) was extracted by L 4 鈮，

本文編號：2494079