右美托咪定对高血压脑出血患者围术期血清IL-6和IL-11的表达及神经功能的影响  

Effecting of preoperative dexmedetomidine using on the expression of serum levels of IL-6 and IL-11 and neurologic function in patients with hypertensive cerebral hemorrhage

作　　者：叶枝秀 吴克义[1] 唐朝亮 董永飞 胡成云 朱海波[2] Ye Zhixiu;Wu Keyi;Tang Chaoliang(Department of Anesthesiology,Lujiang People's Hospital,Hefei,231500,China)

机构地区：[1]庐江县人民医院麻醉科,合肥231500 [2]庐江县人民医院神经外科,合肥231500 [3]中国科学技术大学附属第一医院麻醉科 [4]中国科学技术大学附属第一医院神经外科

出　　处：《立体定向和功能性神经外科杂志》2020年第6期359-362,共4页Chinese Journal of Stereotactic and Functional Neurosurgery

基　　金：国家自然科学基金青年基金项目(编号:81801175);中国博士后科学基金资助项目(编号:2019M662179);安徽省博士后研究人员科研活动经费资助项目(编号:2019B324);中央高校基本科研业务费专项资金资助(编号:WK9110000044)。

摘　　要：目的评价高血压脑出血患者右美托咪定围术期的应用对血清IL-6和IL-11的表达及神经功能的影响。方法全麻下行高血压脑出血颅内血肿清除术的患者60例,性别不限,年龄40~80岁,BMI<35 kg/m2,ASA分级Ⅲ-Ⅳ级,采用随机数字表法分为两组(n=30):右美托咪定组(DEX组),麻醉诱导前15 min静脉泵注右美托咪定0.083 mL/kg/h (0.15μg/kg/h),于术后48h停止泵注;对照组(C组),麻醉诱导前15 min静脉泵注相同容积的生理盐水,于术后48 h时停止泵注。检测两组患者入院时和术后48 h静脉血血清IL-6和IL-11的水平;记录手术时间、麻醉时间、停药后自主呼吸恢复时间和输液量;参照美国国立卫生研究院卒中量(NIH Stroke Scale, NIHSS)评估术前和术后第3 d神经功能缺损程度;采用格拉斯哥预后量表(GOS)评估患者6个月后的预后情况。结果 DEX组自主呼吸恢复时间显著短于C组,输液量显著多于C组(P<0.05);术后血清IL-6和IL-11水平显著低于C组(P<0.05);术后第3 d DEX组的NIHSS评分为(7.33±2.22),显著低于C组的(9.17±2.05)(P<0.05);术后6个月DEX组患者病情转归情况显著优于C组(P<0.05)。结论麻醉诱导前15 min静脉持续性泵注右美托咪定0.083 ml/kg/h (0.15μg/kg/h),能显著减少高血压脑出血颅内血肿清除术患者围术期血清IL-6和IL-11的水平,缩短自主呼吸恢复时间,降低NIHSS评分,提高患者预后,减少神经功能损伤。Objective To evaluate the effect of preoperative dexmedetomidine using on the expression of serum levels of IL-6 and IL-11 and neurologic function in patients with hypertensive cerebral hemorrhage.Methods Sixty patients undergoing removal of intracranial hematoma for hypertensive intracerebral hemorrhage, all genders, aged between 40 and 80 years, BMI < 35 kg/m2,ASA Ⅲ-Ⅳ,were randomly allocated to receive either intravenous dexmedetomidine at 0.083 mL/kg/h(0.15 μg/kg/h) 15 min prior to anesthesia induction, and stopped injection at 48 h after surgery(DEX group) or receive the same volume of saline, and stopped injection at 48 h after surgery(C group).The serum levels of IL-6 and IL-11 was tested at admission time and 48 h after surgery;Duration of surgery and anesthesia, spontaneous breathing recovery time after drug withdrawal, infusion volume, the degree of neurological deficit before and 3 days after surgery evaluated with reference to the National Institutes of Health Stroke Volume(NIH,Stroke, Scale, and NIHSS),and the GOS score six months after surgery were all recorded.Results Spontaneous breathing recovery time after drug withdrawal decreased, and infusion volume increased in the DEX group compared to the C group(P<0.05);The serum levels of IL-6 and IL-11 decreased 48 h after surgery in the DEX group compared to the C group(P<0.05);NIHSS score of the DEX group was(7.33±2.22),significantly lower than that of the C group(9.17±2.05)(P<0.05);The prognosis of patients in the DEX group was significantly better than that in the C group 6 months after operation(P<0.05).Conclusion Preoperative intravenous dexmedetomidine at 0.083 mL/kg/h(0.15 μg/kg/h) can significantly reduce the serum levels of IL-6 and IL-11 in patients undergoing removal of intracranial hematoma for hypertensive intracerebral hemorrhage.More, patients can recover quickly from the anesthesia, decrease the NIHSS score, improve patient prognosis, and reduce neurological impairment.

关 键 词：右美托咪定 高血压脑出血 IL-6 IL-11 神经功能 

分 类 号：R743.34[医药卫生—神经病学与精神病学]