右美托咪定联合舒芬太尼对脑出血患者术后炎性应激反应及神经和认知功能的影响  

Effects of dexmedetomidine combined with sufentanil on postoperative inflammatory stress response and neurological function as well as cognitive function in patients with intracerebral hemorrhage

作　　者：郭庆夺[1] 杨秋影 马美娜[1] 王旭鹏[1] 于红[1] 吴春玲[1] 李睿[1] GUO Qingduo;YANG Qiuying;MA Meina(Department of Anesthesia, Cangzhou Central Hospital,Hebei, Cangzhou 061001,China)

机构地区：[1]河北省沧州市中心医院麻醉科,061001

出　　处：《河北医药》2019年第7期965-970,共6页Hebei Medical Journal

摘　　要：目的观察右美托咪定联合舒芬太尼对脑出血患者术后炎性应激反应、神经功能和认知功能的影响。方法选取2016年3月至2018年3月诊治的脑出血患者120例,随机分为对照组和观察组,每组60例。对照组给予丙泊酚联合舒芬太尼麻醉方案,观察组给予右美托咪定联合舒芬太尼麻醉方案。观察2组麻醉诱导前(T0)、插管时(T1)、切皮时(T2)、拔管时(T3)、拔管后(T4)各时间点应激反应指标[平均动脉压(MAP)、心率(HR)、皮质醇];比较2组术前、术后24 h血清炎性因子[白介素6(IL-6)、白介素10(IL-10)、超敏C-反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)]、外周血Toll样受体2(TLR2)、TLR4表达及神经功能[神经元特异性烯醇酶(NSE)、胶质纤维酸性蛋白(GFAP)、Tau蛋白(Tau)]、认知功能[简易智力状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)]变化。结果 T0时2组MAP、HR、皮质醇比较差异无统计学意义(P>0.05);与T0时比较,T1～T4时对照组MAP、HR、皮质醇显著升高,观察组MAP、HR、皮质醇低于同期对照组(P<0.05)。术前2组血清IL-6、IL-10、hs-CRP、TNF-α、MDA、SOD、外周血TLR2、TLR4表达及NSE、GFAP、Tau、MMSE评分、MoCA评分比较差异无统计学意义(P>0.05)。术后24 h 2组血清IL-6、IL-10、hs-CRP、TNF-α、MDA、外周血TLR2、TLR4表达及MMSE评分、MoCA评分均较治疗前显著升高,NSE、GFAP、Tau、SOD均较治疗前显著降低,差异有统计学意义(P<0.05),且观察组血清IL-6、hs-CRP、TNF-α、MDA、外周血TLR2、TLR4表达及NSE、GFAP、Tau低于对照组,IL-10、SOD、MMSE评分、MoCA评分高于对照组(P<0.05)。结论右美托咪定联合舒芬太尼麻醉用于脑出血患者术中能够通过降低TLR2、TLR4表达减轻术后炎性应激反应,促进患者神经功能和认知功能的恢复。Objective To observe the effects of dexmedetomidine combined with sufentanil on postoperative inflammatory stress response and neurological function as well as cognitive function in patients with intracerebral hemorrhage. Methods A total of 120 patients with intracerebral hemorrhage who were admitted and treated in our hospital from Mar 2016 to Mar 2018 were enrolled in the study. These patients were randomly divided into control group ( n =60) and observation group ( n =60). The patients in control group were treated by propofol combined with sufentanil anesthesia, however,the patients in observation group were treated by dexmedetomidine combined with sufentanil anesthesia.The streess reactions indexes were observed and compared between the two groups before anesthesia induction (T0), tracheal intubation (T1), cutting skin (T2), during extubation (T3) and after extubation (T4). The serum levels of IL-6, IL-10, hs-CRP, TNF-α, and the expression levels of TLR2,TLR4, NSE, GFAP, Tau, as well as MMSE scores, MoCA scores before surgery and at 24h after surgery were observed and compared between the two groups. Results There were no significant differences in the levels of MAP, HR and cortisol at T0 between the two groups ( P >0.05). The levels of MAP, HR and cortisol at T1~T4 in control group were significantly higher than those at T0,moreover,the levels of MAP, HR and cortisol in observation group were significantly lower than those in control group ( P <0.05). Before surgery, there were no significant differences in the serum levels of IL-6, IL-10, hs-CRP, TNF-α, MDA, SOD, the expressions of TLR2, TLR4, NSE, GFAP, Tau, MMSE scores and MoCA scores between the two groups ( P >0.05).After surgery, the serum levels of IL-6, IL-10, hs-CRP, TNF-α, MDA, the expression levels of TLR2,TLR4,and MMSE scores and MoCA scores were significantly increased at 24h after surgery in both groups, however,the levels of NSE, GFAP, Tau, SOD were significantly decreased at 24 h after surgery in both groups ( P <0.05).Moreover the levels

关 键 词：右美托咪定 舒芬太尼 脑出血 炎性应激反应 神经功能 认知功能 

分 类 号：R743.34[医药卫生—神经病学与精神病学]