右美托咪定对颈椎前入路手术患者脑氧代谢和炎性因子的影响  

EFFECTS OF DEXMEDETOMIDINE ON CEREBRAL OXYGEN METABOLISM AND INFLAMMATORY FACTORS IN PATIENTS UNDERGOING ANTERIOR CERVICAL SPINE SURGERY

作　　者：岳海龙 马俊涛 侯国清 李俊杰 张宏岩 YUE Hailong;MA Juntao;HOU Guoqing;LI Junjie;ZHANG Hongyan(Department of Anesthesiology,Tangshan Central Hospita,Tangshan,063000,China)

机构地区：[1]河北省唐山中心医院麻醉科,063000

出　　处：《中国煤炭工业医学杂志》2023年第2期142-148,共7页Chinese Journal of Coal Industry Medicine

基　　金：2021年度河北省医学科学研究课题计划(编号:20211486)。

摘　　要：目的 探究右美托咪定(DEX)在颈椎前入路手术麻醉中对患者脑氧代谢和炎性因子的影响。方法 选取2018年1月—2020年12月实施颈椎前入路手术患者60例,随机分为右美托咪定组(D组)和对照组(C组),每组30例。二组患者均采用全凭静脉麻醉方式进行麻醉维持;右美托咪定组,在麻醉诱导前予负荷剂量1.0μg/kg,输注时间10 min;持续0.4μg/(kg·h)泵入右美托咪定,维持至手术完毕;对照组为等量的0.9%氯化钠溶液代替。在患者麻醉诱导前(T0)、手术完毕后1小时(T1)、术后第1天(T2)、术后第3天(T3)、术后第7天(T4)抽取中心静脉血,检测患者动脉-颈内静脉血氧含量差(Da-jvO_(2))、颈内静脉氧饱和度(SjvO_(2))、脑氧摄入率(CE-RO_(2))、肿瘤坏死因子α(TNF-α)、白细胞介素10(IL-10)、白细胞介素6(IL-6),并详细记录。结果 检测结果显示:T1~T4时间点,两组患者血清TNF-α、IL-6、IL-10水平均显著高于T0时间点,且在T1时间点达峰值,之后逐渐呈下降趋势;且D组TNF-α、IL-6水平显著低于C组,差异有统计学意义(P<0.05);但D组IL-10水平显著高于C组,差异有统计学意义(P<0.05)。二组患者在T1时,SjvO_(2)水平明显升高,T2~T4时逐渐下降,C组T1~T4时明显低于D组,差异有统计学意义(P<0.05)。两组患者在T1时,Da-jvO_(2)、CE-RO_(2)水平均明显减少,在T2~T4时逐渐升高,且C组T1~T4时明显高于D组,差异有统计学意义(P<0.05)。结论 在行颈椎前入路手术麻醉中,右美托咪定可改善患者的血清炎性因子水平,并对脑组织具有保护作用,有利于患者的脑组织灌注及氧供,利于患者的预后。Objective To investigate the effects of dexmedetomidine on cerebral oxygen metabolism and inflammatory factor in patients undergoing anterior cervical approach. Methods Sixty patients underwent anterior cervical approach were divided into dexmedetomidine group and control group(n=30) in our hospital during January 2018 to December 2020.Anesthesia of both groups was to tally maintained by intravenous anesthesia.Dexmedetomidine was used before anesthesia induction of 1.0 μg/kg and injection time of more than 10 min before anesthesia maintenance, and then maintained until the end of operation, the rate of 0.4μg/(kg·h).While in control group, the same amount of 0.9% NaCl was given.At anesthesia induction before operation( T0),one hour after operation( T1),one day after operation( T2),three days after operation( T3) and seven days after operation( T4).Observ the levels of Da-jvO_(2),SjvO_(2),CE-RO_(2),IL-6,TNF-α,IL-10 of two groups. Results The levels of IL-6,TNF-α,IL-10 indexes of two groups were significantly higher than at T0,it peaks at T1 time and gradually declines.The levels of IL-6 and TNF-α of C group were significantly higher than D group at T1~T4.The levels of IL-10 at D group were significantly higher than C group at T1~T4,there were difference significantly(P<0.05).At T1,the levels of SjvO_(2) in two groups was significantly higher, and at T2~T4,the levels of SjvO_(2) in two groups then decreased progressively.D groups at T1~T4,the levels of SjvO_(2) was significantly higher than the levels of SjvO_(2) in C group, the difference was statistically significant(P<0.05).At T1,the levels of Da-jvO_(2),CE-RO_(2) in two groups decreased.At T2~T4,the levels of Da-jvO_(2),CE-RO_(2) in two groups were significantly higher.And the levels of Da-jvO_(2),CE-RO_(2) in C groups were significantly higher than the levels of Da-jvO_(2),CE-RO_(2) in D group.The difference was statistically significant(P<0.05). Conclusion Use of dexmedetomidine can improve the serum levels of inflammatory factors in anterior cervical ap

关 键 词：右美托咪定 颈椎前入路手术 脑氧代谢 炎性因子 

分 类 号：R614[医药卫生—麻醉学]