术中应用Dex对颅脑肿瘤切除患者POD及外周血相关炎症因子的影响:一项基于随机对照试验的探索性研究  

Effect of dexmetomidine on postoperative delirium and inflammatory factors in patients undergoing craniocerebral tumor resection:an exploratory study nested on a randomized controlled trial

作　　者：李沐寒 李若雯 崔倩宇 曾敏[1] 李姝 彭宇明[1] Li Muhan;Li Ruowen;Cui Qianyu;Zeng Min;Li Shu;Peng Yuming(Department of Anesthesiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院麻醉科,北京100070

出　　处：《国际麻醉学与复苏杂志》2022年第10期1026-1032,共7页International Journal of Anesthesiology and Resuscitation

基　　金：国家重点研发项目(2018YFC2001901);首都临床诊疗技术研究及示范应用(Z191100006619068)。

摘　　要：目的探索术中应用右美托咪定(dexmetomidine,Dex)对颅脑肿瘤切除患者术后谵妄(postoperative delirium,POD)及外周血相关炎症因子的影响。方法选取2021年11月—2021年12月于首都医科大学附属北京天坛医院行额颞部肿瘤切除术的患者80例,按随机数字表法分为Dex组和对照组,每组40例,其中20例因为血液样本缺失剔除,故最终入组患者60例(每组30例)。两组患者麻醉其他用药相同基础上,Dex组患者于插管后10 min给予静脉输注Dex 0.6μg/kg负荷剂量,然后以0.4μg·kg−1·h−1的速率持续输注至术中止血,对照组给予等容量生理盐水。术后1~5 d,采用镇静评分(Richmond Agitation‑Sedation Scale,RASS)、精神错乱评估法(Confusion Assessment Method for Intensive Care Uni,CAM‑ICU)及3分钟精神错乱评估法(3‑Minute Diagnostic Interview for CAM,3D‑CAM)相结合的方法对患者进行POD评估,记录两组患者POD发生率。采用化学发光法,检测两组患者诱导后(T1)、试验药物停止输注时(T2)、术毕(T3)时外周血IL‑6、TNF‑α水平,并比较发生POD和未发生POD的患者T1、T2、T3时的外周血IL‑6、TNF‑α水平。比较两组患者术前人口学特征及基线资料及术中资料。根据患者基线资料信息、围手术期临床信息和既往文献报道的相关因素进行POD危险因素的单因素变量筛选,将单因素Logistic回归分析中P<0.1的变量纳入多因素Logistic回归分析,探索神经外科肿瘤患者POD的影响因素。结果对照组术中使用糖皮质激素的患者比例高于Dex组(P<0.05)。Dex组6例(20%)发生POD,低于对照组15例(50%)(P<0.05)。两组患者各时点IL‑6、TNF‑α水平组间比较,差异均无统计学意义(P>0.05)。对照组T3时IL‑6水平高于T2时(P<0.05),而TNF‑α水平各时点间差异无统计学意义(P>0.05);Dex组T3时IL‑6水平高于T1、T2时(P<0.05),T3时TNF‑α水平高于T1时(P<0.05)。发生POD的患者和未发生POD的患者各时点IL‑6和TObjective To explore the effects of dexmedetomidine(Dex)on postoperative delirium(POD)and peripheral blood inflammatory factors in patients undergoing craniocerebral tumor resection.Methods A total of 80 patients who underwent frontotemporal tumor resection in Beijing Tiantan Hospital Affiliated to Capital Medical University from November 2021 to December 2021 were enrolled.According to the random number table method,they were divided into two groups(n=40):a Dex group(group Dex)and a enrolled in this study(30 cases in each group).Group Dex were intravenously infused with a loading dose of 0.6μg/kg followed by continuous infusion at 0.4μg·kg−1·h−1 until intraoperative hemostasis,while the group control were given the same volume of normal saline.Furthermore,other anesthetic agents used in the two group were the same.Then,patients in both groups were evaluated by Richmond Agitation‑Sedation Scale(RASS),the Confusion Assessment Method for Intensive Care Unit(CAM‑ICU),the Three‑Minute Diagnostic Interview for CAM(3D‑CAM)during the initial 5 postoperative days.Their incidences of POD were recorded.The levels of IL‑6 and TNF‑αin blood samples were detected after induction(T1),at the end of infusion(T2)and at the end of operation(T3),as well as in patients with/without POD.Demographic and baseline variables,and intraoperative characteristics were compared between the two groups.The risk factors of POD were screened based on baseline information,perioperative information and previous reports.Those with P<0.1 in the univariate logistic regression analysis were included for multivariate logistic regression analysis,so as to explore the risk factors of POD in neurosurgical tumor patients.Results The proportion of patients using glucocorticoid in the group control was higher than that in the group Dex(P>0.05).There were 6 cases(20%)of POD in the group Dex,which was significantly lower than that in the group control(15 cases,50%)(P<0.05).There was no significant difference in the levels of IL‑6 and TNF�

关 键 词：右美托咪定 炎症因子 术后谵妄 颅内肿瘤手术 

分 类 号：R739.41[医药卫生—肿瘤]