右美托咪定对颅内肿瘤切除患者血流动力学的影响及脑保护效应研究  

Influence of dexmedetomidine on hemodynamics in patients undergoing intracranial tumor resection and its brain protection effect

作　　者：武辉 薛荣亮[2] 李雪丹[3] 陈皎[3] WU Hui;XUE Rong-liang;LI Xue-dan;CHEN Jiao(Xi'an Jiaotong University,Xi'an 710048,Shaanxi,CHINA;Department of Anesthesiology,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,Shaanxi,CHINA;Department of Anesthesiology,Hanzhong Central Hospital,Hanzhong 723000,Shaanxi,CHINA)

机构地区：[1]西安交通大学,陕西西安710048 [2]西安交通大学第二附属医院麻醉科,陕西西安710004 [3]汉中市中心医院麻醉科,陕西汉中723000

出　　处：《海南医学》2022年第7期849-853,共5页Hainan Medical Journal

摘　　要：目的研究右美托咪定对颅内肿瘤切除患者血流动力学的影响及其脑保护效应。方法前瞻性选取2018年6月至2020年6月间西安交通大学第二附属医院收治的择期行颅内肿瘤切除术的86例患者作为研究对象,采用随机数表法将患者分为右美托咪定组和对照组,每组34例。右美托咪定组和对照组患者分别在麻醉诱导前给予右美托咪定及等量生理盐水,于麻醉诱导前(T0)、切皮即刻(T1)、取瘤完毕(T2)、术毕(T3)、术后2 h(T4)记录患者平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)指标;记录患者苏醒时间、拔除气管导管时间;于T0、T3、T4、术后24 h(T5)、术后3 d(T6)时测定并比较两组患者的血清S-100β蛋白、神经元特异性烯醇化酶(NSE)、神经胶质纤维酸性蛋白(GFAP)、肿瘤坏死因子α(TNF-α)及白细胞介素-6(IL-6)水平。结果右美托咪定组患者T2~T4时间点的MAP、HR明显低于对照组,差异均有统计学意义(P<0.05);右美托咪定组患者术后苏醒时间、拔除气管导管时间短于对照组,差异均有统计学意义(P<0.05);T4~T5时间点右美托咪定组血清S-100β、NSE、GFAP明显低于对照组,差异均有统计学意义(P<0.05);T3~T5时间点右美托咪定组血清TNF-α、IL-6水平明显低于对照组,差异均有统计学意义(P<0.05)。结论右美托咪定可降低脑肿瘤手术患者血流动力学波动,促进术后认知功能恢复,抑制炎症因子释放可能为脑损伤保护机制之一。Objective To study the influence of dexmedetomidine on hemodynamics in patients undergoing intracranial tumor resection,and its brain protection effect.Methods This prospective study included 86 patients who underwent elective intracranial tumor resection in the Second Affiliated Hospital of Xi’an Jiaotong University between June2018 and June 2020.Patients enrolled were divided into dexmedetomidine group and control group by random number table method,with 34 cases in each group.The two groups were respectively treated with dexmedetomidine and the same amount of normal saline before anesthesia induction.Mean arterial pressure(MAP),heart rate(HR)and blood oxygen saturation(SpO2)before anesthesia induction(T0),at skin incision(T1),after tumor removal(T2),at the end of surgery(T3),and at 2 h after surgery(T4)were recorded.The recovery time and time of tracheal tube removal were recorded.The levels of serum S-100βprotein,neural specific enolase(NSE),glial fibrillary acidic protein(GFAP),tumor necrosis factorα(TNF-α)and interleukin-6(IL-6)of the two groups at T0,T3,T4,24 h after surgery(T5)and 3 d after surgery(T6)were measured and compared.Results From T2 to T4,MAP and HR of the dexmedetomidine group were significantly lower than those of the control group,with statistically significant differences(P<0.05).The recovery time and time of tracheal tube removal were shorter than those of the control group,with statistically significant differences(P<0.05).Compared with T0,the levels of serum S-100β,NSE,GFAP,TNF-αand IL-6 in both groups increased first and then decreased from T3 to T6,with statistically significant differences(P<0.05).From T4 to T5,the levels of serum S-100β,NSE and GFAP in the dexmedetomidine group were significantly lower than those in the control group,with statistically significant differences(P<0.05).From T3 to T5,the levels of serum TNF-αand IL-6 in the dexmedetomidine group were significantly lower than those in the control group,with statistically significant differences(P<0.05).Conclusio

关 键 词：右美托咪定 颅内肿瘤 麻醉诱导 血流动力学 脑损伤 炎症因子 

分 类 号：R739.41[医药卫生—肿瘤]