Cerebral Protection Of Hypertonic Sodium Chloride Hydroxyethylstarch 40 Injection On Brain Tumor Patients In General Anesthesia Induction Period

【Objective】:To investigate the Cerebral protection of hypertonic sodium chloride hydroxyethyl starch 40 injection(HSS40) on brain tumor patients in general anesthesia induction period.【Methods】:Forty patients(ASAⅠ～Ⅱ) undergoing brain tumor were randomly divided into 2 groups:group H(HSS40),group R(Sodium chloride compound)(n=20).Radial arteries and right jugular veins were catheterized under local anesthesia in all patients.Then group H,group R were injected at a speed of 4ml/kg within 30min for patients.General anesthesia was administered for all patients 30min after solution infusion.Mean arterial pressure(MAP), central venous pressure(CVP) and heart rate(HR) were recorded by PHILIPS multi-function monitor before solution infusion(T0),immediate after infusion (T1),immediate after endotrachial intubations(T2),5 min(T3) after endotrachial intubations,15 min(T4) after endotrachial intubations,30 min(T5) after endotrachial intubations.Human Soluble protein-100B(S100B),Interleukin-6(IL-6) and tumor necrosis factor-a(TNF-a)were measured at same time-points respectively.【Result】:Compared with T0,group H HR reduced mildly and MAP increased slightly,but without statistical significance at T1(P＞0.05);HR and MAP without significant change(P＞0.05),CVP increased obviously(P＜0.05),S100B reduced obviously(P＜0.05) from T2 to T5;IL-6,TNF-a without significant change at each point in time(P＞0.05);group R HR increased obviously and MAP reduced obviously from T2 to T5,(P＜0.05),CVP without significant change at each point in time(P＞0.05);S100B increased obviously at T5 (P＜0.05);IL-6,TNF-a elevated obviously from T3 to T5(P＜0.05)。Compared with group R,group H HR reduced obviously,MAP and CVP elevated obviously from T2 to T5(P＜0.05);S100B,IL-6 and TNF-a reduced obviously from T3 to T5(P＜0.05).【Conclusion】:(1) Compared with T0,group R HR increased obviously and MAP reduced obviously from T2 to T5,(P＜0.05),CVP without significant change at each point in time(P＞0.05).The results indicate that the drugs on the circulatory system in brain tumor patients has inhibition effect during induction of general anesthesia,additionally Cancer organization itself and the surrounding edema,resulting in increased intracranial pressure,autoregulation of cerebral blood flow is loss,thus easily lead to decreased blood pressure,cerebral hypoperfusion.(2) Compared with T0,S100B increased obviously at T5 (P＜0.05);IL-6,TNF-a elevated obviously from T3 to T5(P＜0.05)。.The results indicate that during induction of general anesthesia brain tumor patients has a variety of pleiotropic cytokine production,they form a pathological cytokine networks,the interaction between each other,mediated by a series of chain reactions involved in secondary brain damage.(3) Compared with group R, group H HR reduced obviously,MAP and CVP elevated obviously from T2 to T5(P＜0.05);S100B,IL-6 and TNF-a reduced obviously from T3 to T5 (P＜0.05).The findings of the present study demonstrated that HSS40(4ml/kg) can lower the S100B levels by maintaining the good cerebral perfusion pressure, reducing intracranial pressure,reducing the inflammatory response.HSS40 may play a protective role on brain tumor patients in general anesthesia induction period.