右美托咪啶对重度急性颅脑损伤患者围术期血清肌酸激酶脑型同工酶内脂素及颅内压的影响  

Influence of dexmedetomidine on perioperative serum brain typeisoenzyme of creatine phosphokinase, visfatin and intracranial pressure in patients with severe acute brain injury

作　　者：齐艳艳[1] 姚翔燕[1] 王玉社[1] 杜献慧[1] 

机构地区：[1]河南省人民医院麻醉科,河南郑州450003

出　　处：《中国急救医学》2015年第4期317-322,共6页Chinese Journal of Critical Care Medicine

摘　　要：目的：探讨右美托咪啶对重度急性颅脑损伤患者围术期血清肌酸激酶脑型同工酶（ CK－BB）、内脂素及颅内压的影响。方法选取2012－01～2014－07我院收治的72例拟行急诊手术的重度颅脑外伤患者为研究对象，随机分为对照组（Ⅰ组，n＝36）和右美托咪啶治疗组（Ⅱ组，n＝36），治疗组患者于麻醉诱导前至术后3 d给予静脉泵入右美托咪啶0．5μg／（kg· h），对照组给予等剂量生理盐水处理；分别在麻醉诱导前（T0）、术毕（T1）、术后第1天（T2）、术后第3天（ T3）、术后第7天（ T4）抽取静脉血测定血清CK－BB、内脂素、高敏C－反应蛋白（ hs－CRP），并记录术前、术后各时间点的颅内压（ICP）以及3个月的格拉斯哥预后量表评分（GOS）等级情况。结果与T0比较，两组患者CK－BB、内脂素、hs－CRP水平在T3时达到高峰（P＜0．05），之后开始下降；与Ⅰ组比较，Ⅱ组在T2～T4时CK－BB、内脂素、hs－CRP水平明显降低（ P＜0．05）。两组ICP在术后即明显降低（P＜0．05），但术后T2～T4逐渐升高，随后下降（P＜0．05），Ⅱ组在T3～T4时低于Ⅰ组（P＜0．05）。 Pearson相关分析显示，术后7 d血清内脂素降低幅度（△内脂素）分别与△hs－CRP、△ICP、△CK－BB呈正相关（P＜0．05）；多元逐步回归分析亦提示，△内脂素分别与△ICP及△CK －BB 呈独立相关（ P ＜0．05）。Ⅱ组术后3个月的 GOS 评分中的预后较好率（88.9％）明显高于Ⅰ组（66．7％，χ2＝5．143，P＝0．233）。多因素Logistic回归分析显示，使用右美托咪啶、△内脂素、△CK－BB与预后密切相关（3个月后的GOS评分＜3分）。结论血清内脂素可能参与了颅脑损伤后炎症反应及继发性脑损伤，并且与重度颅脑损伤患者预后密切相关。右美托咪定能够降低重度颅脑损伤患者血清内脂素水平，抑制炎症水平，降低ICP，�Objective To explore influence of dexmedetomidine on perioperative serum brain typeisoenzyme of creatine phosphokinase （ CK -BB ） , visfatin and intracranial pressure （ ICP ） in patients with severe acute brain injury.Methods Seventy-two cases of severe craniocerebral trauma patients received emergency operation from January 2012 to July 2013 in our hospital were selected as research subjects.The patients were randomly divided into control group （ groupⅠ, n =36 ） and treatment group （ groupⅡ, n =36 ） .Patients in treatment group received intravenous injection of dexmedetomidine[0.5μg/kg· h）]from the time before anesthesia induction to postoperative 3 days, and patients in control group were given equal volume of saline.Venous blood samples were collected to determine serum visfatin, CK-BB level and ICP before anesthesia induction （ T0 ） , at the end of the＆amp;nbsp;surgery （ T1 ） , on postoperative 1 day （ T2 ） , 3 days （ T3 ） and 7 days （ T4 ） , respectively; Glasgow outcome scale （ GOS） score was recorded after three months of surgery.Results ①Compared with T0 , serum visfatin, hs-CRP and CK-BB levels increased and reached their peaks on T3（P〈0.05）, then began to decline;compared with groupⅠ, serum visfatin, hs-CRP and CK-BB levels of groupⅡwere significantly lower at T2 -T4（P〈0.05）;ICP of two groups significantly decreased after surgery （P〈0.05）, however increased at T2 -T4, then decreased （P〈0.05）; compared with groupⅠ, ICP of groupⅡwere lower at T3 -T4 （ P〈0.05）.②Pearson correlation analysis showed that drop in serum visfatin after treatment （△visfatin） was positively correlated with △hs -CRP, △ICP, △CK -BB （ P〈0.05 ）; multiple stepwise regression analysis also showed that △visfatin was independently correlated with △ICP, △CK -BB, respectively （P〈0.05）.③Rate of good prognosis in groupⅡ（88.9%） was significantly higher than that in groupⅠ （66.7%） in term of GOS score after thr

关 键 词：右美托咪啶 颅脑损伤 内脂素 肌酸激酶脑型同工酶(CK-BB) 颅内压(ICP) 炎症反应 

分 类 号：R722.120.5[医药卫生—儿科]