静脉泵注右美托咪定对颅脑手术患者炎性因子、脑氧代谢及认知功能的影响研究  

Impact of Intravenous Pumping of Dexmedetomidine on Inflammatory Cytokines,Cerebral Oxygen Metabolism and Cognitive Function of Patients Undergoing Craniocerebral Operations

作　　者：马红梅[1] 郭莹莹[1] 吴智宏[1] 孙立智[1] 

机构地区：[1]北京电力医院麻醉科,北京市100073

出　　处：《实用心脑肺血管病杂志》2016年第11期35-39,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的 探讨静脉泵注右美托咪定对颅脑手术患者炎性因子、脑氧代谢及认知功能的影响。方法 选取2013年1月—2016年1月在北京电力医院行颅脑手术患者130例,根据单盲、随机原则分为对照组57例和观察组73例。对照组患者于术前30 min肌肉注射阿托品并采用丙泊酚、咪达唑仑、舒芬太尼、维库溴铵进行麻醉,观察组患者在此基础上于麻醉诱导前静脉泵注右美托咪定。比较两组患者麻醉前（T1）、麻醉后5 min（T2）、麻醉后30 min（T3）、麻醉后60 min（T4）、麻醉后120 min（T5）炎性因子〔超敏C反应蛋白（hs-CRP）、肿瘤坏死因子α（TNF-α）、白介素6（IL-6）、白介素8（IL-8）〕水平、心率（HR）、收缩压（SBP）、舒张压（DBP）及血氧饱和度（SpO2）,术前24 h、术后24 h脑氧代谢指标〔颈内静脉血氧含量（CjvO2）、动脉氧含量（CaO2）、脑氧代谢率（CERO2）、颈内静脉血氧饱和度（SjvO2）〕及简易智能精神状态评价量表（MMSE）评分。结果 时间与方法在hs-CRP、TNF-α、IL-6、IL-8水平上无交互作用（P〉0.05）;时间在hs-CRP、TNF-α、IL-6、IL-8水平上主效应显著（P〈0.05）;方法在hs-CRP、TNF-α、IL-6、IL-8水平上主效应显著（P〈0.05）;观察组患者T2-T5时hs-CRP、TNF-α、IL-8、IL-6水平低于对照组（P〈0.05）。时间与方法在HR、SBP、DBP、SpO2上无交互作用（P〉0.05）;时间在HR、SBP、DBP上主效应显著（P〈0.05）,在SpO2上主效应不显著（P〉0.05）;方法在HR、SBP、DBP上主效应显著（P〈0.05）,在SpO2主效应不显著（P〉0.05）;观察组患者T2-T4时HR低于对照组（P〈0.05）,T2-T5时SBP、DBP高于对照组（P〈0.05）。术前24 h两组患者CjvO2、CaO2、CERO2、SjvO2及MMSE评分比较,差异无统计学意义（P〉0.05）;术后24 h观察组患者CjvO2、CERO2、SjvO2、MMSE评分高于对照组,CaO2低于对照组（P〈0.05）。结论 静脉泵注右美托咪定可有效�Objective To investigate the impact of intravenous pumping of dexmedetomidine on inflammatory cytokines, cerebral oxygen metabolism and cognitive function of patients undergoing craniocerebral operations. Methods A total of 130 patients undergoing craniocerebral operations were selected in Beijing Electric Power Hospital from January 2013 to January 2016, and they were divided into control group （n = 57） and observation group （n = 73） according to single - blind random principle. Patients of control group received intramuscular injection of atropine before 30 minutes of operation, and then received propofol, midazolam, sufentanil and vecuronium for anesthesia, while patients of observation group received extra intravenous pumping of dexmedetomidine before anesthesia based on that of control group. Inflammatory cytokines （including hs-CRP, TNF-α, IL-6 and IL-8） levels, heart rate （HR）, systolic blood pressure （SBP）, diastolic blood pressure （DBP） and oxyhemoglobin saturation （ SpO2 ） before anesthesia （ T1 ） , after 5 minutes of anesthesia n （ T2 ） , after 30 minutes of anesthesia （ T3 ） , after 60 minutes of anesthesia （ T4 ） and after 120 minutes of anesthesia （ T5 ） , index of cerebral oxygen metabolism [ internal jugular venous blood oxygen content （ CjvO2 ）, internal carotid artery blood oxygen content （ CaO2 ）, cerebral oxygen extraction rate （ CERO2 ） and jugular venous oxygen saturation （SjvO2） ] and MMSE score before 24 hours of anesthesia and after 24 hours of anesthesia were compared between the two groups. Results There was no interaction between time and method in hs-CRP, TNF-α, IL-6 or IL-8 （P 〉0. 05） ; the main effects of time and method were significant in hs-CRP, TNF-α, IL-6 and IL-8 （P 〈0.05） ; hs-CRP, TNF-α, IL-6 and IL-8 of observation group were statistically significantly lower than those of control group from T2 to T5 （P 〈 0. 05）. There was no interaction between time and method in HR, SBP, DBP or SpO2 （P

关 键 词：神经外科手术 麻醉 脑损伤 脑肿瘤 右美托咪定 炎症趋化因子类 

分 类 号：R651[医药卫生—外科学]