右美托咪定对脑膜瘤切除术患者磷脂肌醇3激酶和一氧化氮合酶浓度的影响  

The effect of dexmedetomidine on phosphatidylinositol 3 kinase and inducible nitric oxide synthase concentration in patients with meningioma resection

作　　者：高瑞萍[1] 张喜洋[1] 李爱梅[1] 石翊飒[1] 路文胜[1] 白武民[1] 杨小华[1] 

机构地区：[1]兰州大学第二医院麻醉科,730030

出　　处：《临床麻醉学杂志》2013年第6期560-563,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨右美托咪定对脑膜瘤切除术患者磷脂肌醇3激酶(PI3K)及血清诱导型一氧化氮合酶(iNOS)浓度的影响。方法选择择期行脑膜瘤切除术患者45例,年龄45～65岁,ASAⅡ或Ⅲ级,采用随机数字表法,将患者随机均分为右美托咪定0.2μg·kg-1·h-1组(D1组)、右美托咪定0.5μg·kg-1·h-1组(D2组)和对照组(C组),D1和D2组于诱导前10min静注右美托咪定负荷量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组给予等容量生理盐水。三组术中BIS值维持在40～49,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PI3K及iNOS浓度,且分别于T1～T3时采集桡动脉及颈静脉球部的血样行血气分析,记录并计算动脉血氧含量(CaO2)、脑动脉-静脉血氧含量差(Da-jvO2)和脑氧摄取率(CERO2)。结果 T2～T4时三组患者血清PI3K、iNOS浓度明显高于T1时(P<0.05),D2组血清PI3K、iNOS浓度明显低于C组(P<0.05)。T2、T3时三组患者血清CaO2、Da-jvO2和CERO2含量明显低于T1时(P<0.05),D1、D2组血清CaO2、Da-jvO2和CERO2含量明显低于C组(P<0.05)。结论静脉输注右美托咪定可对围术期脑膜瘤患者发挥脑保护作用,其机制可能与降低血PI3K和iNOS的浓度有关。Objective To evaluate the effect of dexmedetomidine on Phosphatidylinositol 3 kinase and Inducible nitric oxide synthase concentration in patients with meningioma resection. Methods Forty-five ASA Ⅱ or Ⅲ meningioma patients, aged 45-65 years weighing 55 65 kg scheduled for elective intracranial tumor resection were randomly divided into 3 groups（n： 15）： control group （group C）; low-dose Dex group （group D1）; high dose Dex group （group D2）. Dexmedetomidine was intravenously infused 10 rain before induction at the dose of 1μg/kg, followed by constant speed infusion at 0.2μg·kg-1·h-1 and 0.5μg·kg-1·h-1 in group D1 and D2 respectively until 30 rnin before the end of the operation. Group C received the same volume of saline. BIS was maintained at 40-49. Venous blood samples were taken for deter mination of serum concentrations of iNOS and PI3K respectively before induction （T1）, at the time of dislodging tumor （T2）, when extubating trachea（T3） and 24 h after operation（T4 ）. Blood samples were also collected from radial artery and jugular venous bulb for blood gas analysis to calculate the CaO2, Da-jvO2 and CERO2. Results Compared with T1 , the concentration of iNOS and PI3K in serum significantly increased at T2-T4 in the all groups（P〈0.05）. Compared with group C, the concentration of iNOS and PI3K were significantly lower at T2-T4 in group D2（P〈0.05）. Compared with T1 ,CaO2 ,Da-jvO2 and CERO2 in the three groups at T2, T3 were decreased significantly （P〈0. 05）. Compared with group C, CaO2, Da-jvO2 and CEROe were decreased at T2-T3 in group D1 and D2（P〈0. 05）. Conclusion Intraoperative infusion of dexmedetomidine may play a protective effect on patients with meningiorna. The mechanism may be associated with reducing plasma PI3K and iNOS concentrations.

关 键 词：右美托咪定 神经保护 脑膜瘤切除术 

分 类 号：R614[医药卫生—麻醉学]