右美托咪定对行开颅手术患者炎性反应的干预作用  

Intervention with dexmedetomidine on inflammatory response following craniotomy

作　　者：任长和[1] 吴刚明[1] 李刚[1] 张杨[1] 俞虹[1] 欧册华[1] 

机构地区：[1]泸州医学院附属医院麻醉科,四川泸州646000

出　　处：《上海医学》2015年第6期489-492,共4页Shanghai Medical Journal

摘　　要：目的通过测定开颅手术中应用右美托咪定(DEX)的患者血清IL-6、TNF-α水平和手术前后24h简易精神状态检查表(MMSE)评分,探讨DEX对开颅手术患者炎性反应和认知功能的干预作用。方法选取45例择期行开颅手术的患者,随机分入对照组、DEX0.5组(DEX负荷剂量和维持剂量分别为0.5μg/kg和0.5μg·kg-1·h-1)和DEX1.0组(DEX负荷剂量和维持剂量分别为1.0μg/k和1.0μg·kg-1·h-1)。分别于手术前、后24h对患者进行MMSE评分,计算手术前后MMSE评分的差值(ΔMMSE),采用放射免疫法检测患者术前24h(T0)、切开硬脑膜后(T1)、手术结束时(T2)和术后24h(T3)各时间点的血清IL-6、TNF-α水平。结果 DEX0.5组和DEX1.0组术后24h的MMSE评分均显著高于对照组同时间点(P值均<0.05),ΔMMSE均显著低于对照组(P值均<0.05);DEX0.5组与DEX1.0组间术后24h的MMSE评分和ΔMMSE的差异均无统计学意义(P值均>0.05)。对照组术后24h的MMSE评分显著低于同组术前24h(P<0.05)。DEX0.5组T2、T3时间点和DEX1.0组T1、T2、T3时间点的血清IL-6和TNF-α水平均显著低于对照组同时间点(P值均<0.05),DEX1.0组T2、T3时间点的血清IL-6和TNF-α水平均显著低于DEX0.5组同时间点(P值均<0.05)。3组T1、T2、T3时间点的血清IL-6和TNF-α水平均显著高于同组T0时间点(P值均<0.05),3组T2、T3时间点的血清IL-6和TNF-α水平均显著高于同组T1时间点(P值均<0.05),3组T2时间点的血清IL-6水平均显著高于同组T3时间点(P值均<0.05)。结论 DEX能够降低行开颅手术患者术后血清IL-6和TNF-α水平,减轻术后炎性反应,提高MMSE评分。Objective To detect the levels of serum interleukin-6 （IL-6） and tumor necrosis factor-alpha （TNF-α） and the change of mini mental status examination （MMSE） scores when dexmedetomidine （DEX） was applied during craniotomy, and to explore the effect of DEX on inflammatory response and cognitive function. Methods Forty-five patients scheduled for craniotomy were randomly divided into 3 groups： control group, DEX0. 5 group （loading close and maintenance dose of DEX was 0. 5 μg/kg and 0. 5μg·kg^-1 respectively）, DEXI. 0 group （loading dose and maintenance dose of DEX was 1. 0 μg/kg and 1.0 μg·kg^-1, respectively）. MMSE scores were assessed 24 h before and after surgery. Serum IL-6 and TNF-α levels were determined by radioimmunoassay at the following time points： 24 h before operation （To）, after endocranium was cut open （T1）, the end of the surgery （T2） and 24 h after operation （T3）. Results MMSE scores of DEX0.5 group and DEX1. 0 group were significantly higher than that of control group 24 h after surgery （both P〈0.05）, while ZIMMSE of DEX0.5 group and DEX1. 0 group were significantly lower than that of control group （both P〈0.05）. There were no significant differences in MMSE scores or AMMSE between DEX0.5 group and DEX1.0 group 24 h after surgery （both P〈0.05）. MMSE score at T3 was significantly lower than that at 24 h in the control group （P〈0.05）. The levels of serum IL-6 and TNF-α of DEX0.5 group at T2 and T3 and those of DEX1. 0 group at T1 ,T2 and T3 were significantly lower than those of control group （all P〈0.05）. The levels of serum IL-6 and TNF-a of DEXl. 0 group were significantly lower than those of DEX0.5 group at T2 and T3 （all P〈 0.05）. In the three groups, IL-6 and TNF-a levels at T1, T2 and T3 were significantly higher than those at T0 （all P〈0.05） ; IL-6 and TNF-a levels at T2 and T3 were significantly higher than those at T1 （all P〈0.05） ; IL-6 and TNF-α levels at T2 were significantly higher tha

关 键 词：脑保护 右美托咪啶 炎性反应 简易精神状态检查表 白细胞介素-6 肿瘤坏死因子-α 

分 类 号：R614[医药卫生—麻醉学]