【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。雖然有多種方法可以用于腦膜瘤的治療,但手術切除腦膜瘤是唯一有效的方法,臨床上手術切除腫瘤時硬腦膜切開導致的腦組織腫脹和腫瘤切除減壓可導致腦組織缺血再灌注損傷,嚴重影響患者的預后和生命安全。雖然已有實驗證實缺血預處理具有減輕腦缺血再灌注損傷的作用,但是其臨床應用的不可操作性和創(chuàng)傷性限制了其臨床應用。非缺血預處理的方法中已經(jīng)證實高壓氧,電針和吸入麻醉劑等預處理方法可以減輕缺血再灌注損傷,但在臨床應用中具有一定的局限性。許多動物實驗研究已證實遠程缺血預處理具有減輕心、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對照試驗研究也證實,遠程缺血預處理可減輕心血管手術時心肌的缺血再灌注損傷。這對我們預防腦膜瘤切除手術后產(chǎn)生的腦缺血再灌注損傷提供了新的思路。由于遠程缺血預處理具有方便安全、無創(chuàng)傷且臨床操作簡便易行等優(yōu)點。設計本研究旨在探討遠程缺血預處理對腦膜瘤切除術后腦缺血再灌注損傷的保護作用,為將來其大規(guī)模臨床應用提供科學依據(jù)。 目的 通過對圍術期腦組織損傷具有特異性的生化指標的觀察和神經(jīng)功能評分,探討遠程缺血預處理對腦膜瘤切除術后腦缺血再灌注損傷的保護作用。 方法 56例擇期行腦膜瘤切除術的腦膜瘤患者在麻醉誘導前隨機分成兩組:遠程缺血預處理組26例和對照組30例。遠程缺血預處理參照文獻使用充氣式止血帶對右上肢實施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。分別于麻醉誘導前、誘導后預處理前、硬腦膜切開前、硬腦膜切開后4小時,24小時,3天和7天采集血液標本檢測血清S-100B和神經(jīng)元特異性烯醇化酶(NSE)的濃度,檢測誘導后預處理前、硬腦膜切開前及硬腦膜切開后4小時和24小時的腦脊液S-100B和神經(jīng)元特異性烯醇化酶(NSE)的濃度。并于術前及術后2天和術后7天對患者神經(jīng)功能學進行評分。 結果 1.對血清生化指標的影響。生化指標檢測表明預處理組血清NSE水平在硬腦膜切開后4和24小時與對照組相比較明顯降低(P0.05)。 2.對腦脊液血清生化指標的影響。腦脊液中預處理組硬腦膜切開后4小時和24小時NSE和S100B的濃度與對照阻閉較均明顯降低(P0.05)。 3.預處理組的神經(jīng)功能學評分在術后2天和7天均好于對照組。 結論 本研究結果證實,遠程缺血預處理對腦膜瘤切除術后腦缺血再灌注損傷具有保護作用,可以改善患者的預后提高術后生活質(zhì)量。這項新的研究結果為將來遠程缺血預處理在臨床腦膜瘤切除術中的應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，

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