右美托咪定对老年颈内动脉内膜剥脱术患者脑损伤的影响  

Effect of Dexmedetomidine on Brain Injury under Carotid Endarterectomy in Old Patients

作　　者：周南[1] 金强[1] 高明涛[1] 周锦[1] 张铁铮[1] 

机构地区：[1]沈阳军区总医院麻醉科,辽宁沈阳110016

出　　处：《创伤与急危重病医学》2015年第5期292-296,共5页Trauma and Critical Care Medicine

基　　金：辽宁省自然科学基金(201302194)

摘　　要：目的探讨右美托咪定(Dex)对老年颈内动脉内膜剥脱术患者S100β、神经元特异性烯醇化酶(NSE)蛋白、简易智能量表(MMSE)评分及认知功能的影响。方法选择全身麻醉下行颈内动脉内膜剥脱术患者40例,随机数字表法均分为Dex组(D组)和对照组(C组)。D组麻醉诱导前15 min内静脉泵注负荷剂量Dex 1μg/kg,然后以0.5μg/(kg·h)速度持续泵注至手术结束前30 min;C组泵注等容量生理盐水。记录入手术室(T0)、麻醉诱导前(T1)、气管插管前(T2)、气管插管后(T3)、切皮前(T4)、切皮后(T5)、气管拔管前(T6)和气管拔管后(T7)平均动脉压(MAP)和心率(HR),计算应用负荷剂量Dex、气管插管、切皮和气管拔管等重要刺激前后MAP和HR的变化幅度[(T1-T0)/T0、(T3-T2)/T2、(T5-T4)/T4、(T7-T6)/T6],作为术中血流动力学是否稳定的指标。检测入手术室、术毕和术后1 d颈内静脉球血清S100β和NSE蛋白水平,并记录术前1 d,术后1、3和7 d的MMSE评分及认知功能。结果 2组T0时点和(T1-T0)/T0的MAP和HR差异无统计学意义;D组(T3-T2)/T2、(T5-T4)/T4、(T7-T6)/T6的MAP和HR,均明显小于C组,差异有统计学意义(P<0.05)。血清S100β和NSE蛋白水平,2组术前比较差异无统计学意义,术毕和术后1 d均明显高于术前,且C组明显高于D组,差异均有统计学意义(P<0.05)。MMSE评分,2组术后1、3和7 d均明显低于术前1 d,差异有统计学意义(P<0.05);但2组各时间点比较,差异无统计学意义。结论 Dex可明显降低老年颈内动脉内膜剥脱术患者的S100β和NSE蛋白水平,但MMSE评分无变化。Objective To investigate the effects of dexmedetomidine on S10013, neuron-specific enolase （NSE） and mini mental state examination （MMSE） under carotid endarterectomy in old patients. Methods Forty patients undergoing carotid endarterectomy were randomly divided into dexmedetomidine （D） group and control （C） group. Loading dose of dexmedetomidine （ 1 μg/kg） was injected into patients from D group within 15 minutes before anesthesia induction. Afterwards,0. 5 μg/（ kg h） of dexmedetomidine was continuously infused until 30 minutes before the end of surgury. The same volume of normal saline was used in patients from group C. Mean arterial pressure （MAP） and heart rate （HR） were obtained when the patients entered the operating room （T0）, before anesthesia induction （T1）, before tracheal intubation （T2）, after tra- cheal intubation （ T3 ）, before skin incision （ T4）, after skin incision （ T5 ）, before tracheal extubation （ T6 ） and after tracheal extubation （ T7 ）. The variation of MAP and HR before and after the loading dose of dexmedetomidine, tracheal intubation, skin incision and tracheal extubation were calculated to reflect the haemodynamics stability. The levels of S10013 and NSE in internal jugular vein ball serum were detected at the moment the patients entered the operating room, the end of the surgury and 1 day after the surgury. The MMSE score were obtained 1 day before the surgury,1,3 and 7 days after the sur- gnry. Resdts The MAP and HR has no significant difference between two groups on TO and （ T1 -T0 ）/T0（ P 〉 0.05 ）. The variation of MAP and HR before and after tracheal intubation, skin incision and tracheal extubation were significantly lower in D group than in C group（ P 〈 0.05 ）. There were no significant difference of the serum S10013 and NSE levels between the two groups before the surgnry, while both group elevated significantly at the end of the surgury and 1 day after the surgnry （P 〈 0.05 ） and those of

关 键 词：颈内动脉内膜剥脱术 右美托咪定 S100Β 神经元特异性烯醇化酶 简易智能量表评分 

分 类 号：R614[医药卫生—麻醉学]