右美托咪定在颈椎手术中的脊髓保护作用  

Analysis of spinal protection of dexmedetomidine during cervical surgery

作　　者：滕成玲[1] 吕德珍[1] 赵玉[1] 

机构地区：[1]南京军区南京总医院麻醉科,南京210002

出　　处：《实用药物与临床》2016年第8期965-968,共4页Practical Pharmacy and Clinical Remedies

摘　　要：目的探讨右美托咪定对颈椎手术患者的脊髓保护作用及其作用机制。方法选择2012年11月至2014年12月在我院麻醉科拟在全麻辅助下行颈椎手术的67例患者,记录炎性指标、生命体征、脊髓功能等。随机分为观察组(右美托咪定组,35例)和对照组(生理盐水组,32例)。比较两组患者的术中生命体征、术前及术后的炎性指标、神经元损伤相关指标及脊髓神经功能。结果 T_0(麻醉诱导前)、T_1(输注右美托咪定或生理盐水前)、T_4(拔除喉罩后)时,两组患者的MAP、HR及CVP比较差异无统计学意义(P>0.05);T_2(右美托咪定负荷量静注后15 min)、T_3(手术开始后10 min)时,观察组MAP高于对照组,HR、CVP低于对照组(P<0.05)。术前两组患者的炎性指标、脊髓功能指标比较差异无统计学意义(P>0.05);术后1 d、3 d时,观察组TNF-α、IL-6、CRP、GFAP、NSE及MMP-9水平均低于对照组(P<0.05)。术后7 d时,观察组患者JOA评分高于对照组(14.9±3.0 vs.14.0±2.1,P<0.05)。结论右美托咪定能缓解颈椎术后脊髓继发损伤的程度,具有脊髓保护功能。Objective To discuss the spinal protection of dexmedetomidine for patients with cervical surgery and its mechanisms. Methods Totally 67 patients undergoing cervical spine surgery under general anesthesia in our hospital from November 2012 to December 2014 were randomly divided into two groups ,patients in observation group （n = 35 ） were given dexmedetomidine before the operation, and patients in control group （n = 32 ） received the same amount of normal saline. The intraoperative vital signs, inflammatory indexes, neuron damage correlated indexes and spinal nerve function before and after operation in the two groups were compared. Results There was no significant difference in the levels of MAP, HR and CVP at To （ before anesthesia induction） , T1 （ before the infusion of dexme- detomidine or normal saline） and T4 （after removal laryngeal mask） between the two groups （P 〉 0.05 ） ;the MAP in observation group was higher than that of control group at T2 （ 15 min after infusion of loading dexmedetomidine） and T3 （10 min after the beginning of operation） ,and the levels of HR and CVP were lower. No significant difference was observed in the inflammatory indexes and spinal cord function between the two groups preoperatively （ P 〉 0.05 ） ; the levels of TNF-ct, IL-6, CRP, GFAP, NSE and MMP-9 in observation group were lower than those of control group at 1 d and 3 d after the surgery （ P 〈 0.05 ）. The JOA score in observation group was higher than that of control group at 7 d after the surgery （ P 〈 0.05 ）. Conclusion Dexmedetomidine can alleviate the degree of secondary spinal cord injury after cervical surgery and protect the spinal cord function.

关 键 词：右美托咪定 颈椎手术 脊髓 保护作用 

分 类 号：R614[医药卫生—麻醉学]