右美托咪定对急性颅脑损伤患者围术期炎性反应的影响  

Effect of dexmedetomidine on inflammatory response during perioperative period in patients with acute craniocerebrai trauma

作　　者：魏红芳[1] 陈永学[1] 李书河[1] 杨晓彬[1] 王新波[1] 缪芸[1] 吕航宇[1] 

机构地区：[1]河北省邯郸市中心医院麻醉科,056001

出　　处：《中华麻醉学杂志》2012年第10期1249-1251,共3页Chinese Journal of Anesthesiology

摘　　要：目的探讨右美托咪定对急性颅脑损伤患者围术期炎性反应的影响。方法颅脑损伤的患者70例，性别不限，年龄20～68岁，ASA分级I～Ⅳ级，受伤24h内行去骨瓣诚压术，采用随机数字表法，将患者随机分为2组（n=35）：对照组（C组）和右美托咪定组（D组）。静脉注射芬太尼、异丙酚、顺阿曲库铵行麻醉诱导，术中均以瑞芬太尼、七氟醚、异丙酚维持麻醉，间断追加顺阿曲库铵。D组麻醉诱导前经10min静脉输注右美托咪定1μg／kg，继以0．4／μg·kg-1·h-1的速率静脉输注2h。于麻醉诱导前、手术开始2h、术毕、术后24h（T1～T4）时抽取静脉血样，测定血清神经元特异性烯醇化酶（NSE）、IL-6和TNF-a浓度。结果与c组比较，D组血清NSE、TNF-a和IL-6浓度降低（P〈0．05）；与T1时比较，C组T2、L时血清NSE、TNF-a和IL-6浓度升高，T4时血清TNF．a浓度降低，D组L、L时血清NSE和IL-6浓度升高，L时降低，B、T4时血清TNF—a浓度升高（P〈0．05）。结论右美托咪定可通过抑制急性颅脑损伤患者围术期全身炎性反应，从而产生脑保护作用。Objective To investigate the effect of dexmedetomidine on inflammatory response during the perioperative period in patients with acute craniocerebral trauma. Methods Seventy ASA Ⅰ -Ⅳ patients of both sexes, aged 20-68 yr, with craniocerebral trauma, who required decompressive craniectomy within the next 24 h, were randomly divided into 2 groups （ n = 35 each） ： control group （group C） and dexmedetomidine group （group D）. Anesthesia was induced with fentanyl, propofol and cisatracurium and maintained with remifentanil, sevoflurane and propofol and intermittent iv boluses of cisatracurium. In group D, dexmedetomidine 1 /zg/kg was infused over 10 min, followed by infusion at 0.4 μg-1. kg-1 . h-1 for 2 h. Venous blood samples were taken before induction of anesthesia （baseline）, 2 h after the beginning of operation, at the end of operation and at 24 h after operation （TI-T4 ） to determine the concentrations of serum neurone specific enolase （NSE）, interleukin-6 （IL-6） and tumor necrosis factor-alpha （TNF-a）. Results Compared with group C, the concentrations of serum NSE, IL-6 and TNF-a were significantly decreased in group D （ P 〈 0.05）. The concentrations of serum NSE, IL-6 and TNF-a were significantly higher at T2 and T3 , and the concentration of serum TNF-a was significantly lower at T4 than at Tl in group C （ P 〈 0.05）. The concentrations of serum NSE and IL-6 were significantly higher at TE and T3 and lower at T4 and the concentration of serum TNF-a was significantly higher at T3 and T4 than at TI in group D （ P 〈 0.05 ）. Conclusion Dexmedetomidine protects the brain against acute craniocerebral trauma by inhibiting systemic inflammatory response during the perioperative period.

关 键 词：右美托咪啶 颅脑损伤 全身炎症反应综合征 

分 类 号：R614[医药卫生—麻醉学]