盐酸右美托咪啶对脑膜瘤患者围术期的脑保护效应  

The neuroprotective effect of dexmedetomidine during periopererative period in patients with meningioma

作　　者：李爱梅[1] 石翊飒[2] 李雅楠[1] 韩杰[1] 高瑞萍[2] 张喜洋[2] 

机构地区：[1]甘肃省兰州大学第二临床医学院,730030 [2]兰州大学第二医院麻醉科

出　　处：《国际麻醉学与复苏杂志》2013年第5期403-407,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：目的评价盐酸右美托咪啶（dexmedetomidine，DEX）对脑膜瘤患者围术期的脑保护效应。方法本研究采用前瞻性随机双盲对照设计，选择择期行脑膜瘤切除术患者45例，年龄45岁-65岁，体重在55kg-65kg，美国麻醉医师协会（ASA）分级Ⅱ-Ⅲ级，采用随机数字表法，将患者随机分为3组（每组15例）：生理盐水对照组（c组），DEX低剂量组（D1），DEX高剂量组（D2），D1和D2组于常规诱导前10min静脉输注DEX负荷量1μg／kg，继之分别以0．2μg·kg-1．h-1和0．5μg·kg-1.h-1 持续输注至术毕前30min，C组给予等容量的生理盐水。3组术中维持脑电双频指数（bispectralindex，ms）值在40-49之间，分别于麻醉诱导前（T1），取出肿瘤时（T2），拔管时（T3），术后24h（T4）采集静脉血样，测定血清中S100β及神经元特异性烯醇化酶（neuron-specificenolase，NSE）的浓度，且分别于T1、T2、T3采集桡动脉及颈静脉球部的血样行血气分析，记录并计算脑氧摄取率（cerebralextractionof O2，CEO2）。观察患者围术期血压、心率变化。结果与T1时比较，3组T2也时血清S100β、NSE浓度及CEO2升高（P〈0．05）；T2-T4时C组血清NSE[（20．1±1．7）、（26．5±2．9）、（36．1±2．5）μg，L]与D2组血清NSE[（13．9±2．3）、（16．4±2．4）、（20．0±2．9）μg／L]比较差异有统计学意义（P〈0．05），T2-T4时C组血清S100β浓度[（0．73±0．08）、（0．86±0．08）、（1．17±0．20）μg／L]与D2组血清S100β浓度[（0．65±0．05）、（0．73±0．06）、（0．896±0．051）μg／L]比较差异有统计学意义（P〈0．05），C组与D1组血清NSE、S100β变化比较差异无统计学意义。T2-T3时c组CEO2[（0．36±0．03）、（0．34±0．03）]，与D1组[（0．33±0．04）、（0．30±0．04）]比较差异有统计学意义（P〈0．05），与D2组[（0．32±0．04）、（0．26±0．04）]比较差异有统计学�Objective To evaluate the neuroprotective effect of dexmedetomidine （DEX） during perioperative period in patients with meningioma. Methods This was a prospective, double-blind, and placebo controlled study. Forty-five ASA Ⅱ-Ⅲ patients with meningioma aged 45 y-65 y weighing 55 kg-65 kg scheduled for elective intracranial tumor recection were enrolled and randomly divided into 3 groups （n= 15 ） ： control group （group C ） ; low-dose DEX group （group D 1 ） ; high dose DEX group （group D2）. DEX 1 μg/kg was infused i.v. 10 min before anesthesia induction, and then was infused at a rate of 0.2 μg.kg-1.h-1（group Dl）and 0.5 μg.kg-1.h-1 （group D2） until 30 min before the end of the operation. Group C received the equal volume of normal saline. Bispectral index （BIS） was maintained at 40-49. Venous blood samples were taken before intuction （T1）, while the tumor was rereseeted（Tz）, extubation（T3）, and 24 h after operation（T4） for determination of serum concentrations of S100β and neuron-specific enolase（NSE）. Blood samples were also collected from radial artery and jugular venous bulb for blood gas analysis to calculate the cerebral extraction of O2 （CEO2）. The changes of BP, HR during perioperative period were recorded. Results Compared with T1, the concentration of S100β and NSE in serum and CEO2 were significantly increased at T2-T4 in the three groups （P〈0.05）. There was significant difference between group C and group D2 in the concentration of S100β and NSE in serum at T2-T4（P〈0.05）. The numerical values of NSE in serum in group C were [ （20.1±1.7）, （26.5±2.9）, （36.1±2.5） μg/L], while that of group D2 were [ （13.9±2.3）, （16.4±2.4）, （20.0±2.9） μg,/L], respectively at T2-T4. The numerical values of S100β in serum in group C were [（0.73±0.08）, （0.86±0.08）, （1.17±0.20） μg/L], while that of group D2 were [ （0.65±0.05）, （0.73±0.06）, （0.896±0.051） μg/L] ,respectively at T2-T4. There

关 键 词：盐酸右美托咪啶 神经保护 脑膜瘤 脑氧摄取率 

分 类 号：R614[医药卫生—麻醉学]