小剂量右美托咪定在急性缺血性脑卒中患者取栓术中的应用效果及对血清S100β蛋白、CCNI蛋白的影响  

Effects of low-dose dexmedetomidine on serum S100βprotein and CCNI protein in patients with acute ischemic stroke during thrombectomy

作　　者：赵振儒 王孟楠 关娇 王莉萍 任建华[2] 曾丹 ZHAO Zhenru;WANG Mengnan;GUAN Jiao;WANG Liping;REN Jianhua;ZENG Dan(Department of Anesthesiology,Chengde Central Hospital,Chengde Hebei 067000,China)

机构地区：[1]承德市中心医院麻醉科,河北承德067000 [2]承德市中心医院神经诊断科,河北承德067000 [3]承德市中心医院手术室,河北承德067000

出　　处：《中国急救复苏与灾害医学杂志》2024年第1期42-46,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：承德市科技计划项目(编号:202002A015)。

摘　　要：目的 探讨小剂量右美托咪定在急性缺血性脑卒中(AIS)患者机械取栓术中的应用效果及对血清中枢神经特异性蛋白(S100β)及血浆中富含半胱氨酸蛋白61(CCNI)水平的影响。方法 选取自2018年1月—2021年12月收治的行介入机械取栓术治疗的AIS患者89例,随机分为三组,对照组、小剂量组、大剂量组。小剂量组(30例)、大剂量组(30例)在麻醉诱导前10 min均静脉泵注右美托咪定1.0μg/(kg·h)后维持剂量分别为0.4、0.8μg/(kg·h),直至气管拔管,对照组(29例)静脉泵注等容量生理盐水。于入室给药前(T0)、麻醉诱导后(T1)、维持剂量持续泵注右美托咪定10 min(T2)、术毕带管恢复自主呼吸(T3)时对三组血清S100β蛋白、CCNI蛋白进行检测,并对比三组术后24 h镇静、NIHSS评分、穿刺-血管再通(PTR)时间、苏醒时间的差异以及躁动、谵妄发生率。结果 对照组T1~T3时血清S100β蛋白、CCNI蛋白与T0时的数值相比较差异无统计学意义(P>0.05),小剂量组与大剂量组T1~T3时血清S100β蛋白、CCNI蛋白均明显低于T0时的数值(P<0.05)。T0时,三组血清S100β蛋白、CCNI蛋白比较差异无统计学意义(P>0.05);T1~T3时,小剂量组与大剂量组血清S100β蛋白、CCNI蛋白均明显低于对照组,且小剂量组显著低于大剂量组(P<0.05)。小剂量组、大剂量组术后24 h的Ramsay评分、NIHSS评分、PTR及苏醒时间均优于对照组(P<0.05);小剂量组NIHSS评分明显低于大剂量组(P<0.05),但两组的Ramsay评分、PTR以及苏醒时间差异无统计学意义(P>0.05)。小剂量组、大剂量组躁动、谵妄的发生率明显低于对照组(P<0.05),但小剂量组、大剂量组比较,差异无统计学意义(P>0.05)。大剂量组低血压、心动过缓的发生率明显高于小剂组与对照组(P<0.05),但小剂量组与对照组差异无统计学意义(P>0.05)。结论 在AIS患者机械取栓术中大、小剂量右美托咪定均可降低S100β蛋白、CCNI蛋白水平,而1.0Objective To investigate the effect of low-dose dexmedetomidine on mechanical thrombectomy in patients with acute ischemic stroke(AIS)and its effect on serum CNS-specific protein(S100β)and plasma cysteine-rich protein 61(CCNI)levels.Methods A total of 89 patients with AIS who underwent interventional mechanical thrombectomy from January 2018 to December 2021 were selected and randomly divided into 3 groups:control group,low-dose group,and high-dose group.The control group(29 cases)was injected with the same volume of normal saline,and the low-dose group(30 cases)and the high-dose group(30 cases)were intravenously injected with dexmedetomidine 1.0μg/(kg·h)10 minutes before induction of anesthesia).The maintenance doses after 0.4 and 0.8μg/(kg·h)until the trachea was extubated.The serum S100βprotein and CCNI protein of the three groups were detected before administration in the room(T0),after induction of anesthesia(T1),infusion of dexmedetomidine for 10 minutes(T2),and recovery of spontaneous breathing with a tube after the operation(T3),and the differences in sedation,NIHSS score,puncture-vascular recanalization(PTR)time,recovery time,and the incidence of agitation and delirium at 24 hours after surgery were compared among the three groups.Results There was no significant difference in serum S100βprotein and CCNI protein between T1-T3 and T0 in the control group(P>0.05),Serum S100βprotein and CCNI protein at T1-T3 in low-dose group and high-dose group were significantly lower than those at T0(P<0.05).At T0,the serum S100βprotein and CCNI protein of the three groups had no statistical significance(P>0.05);at T1 to T3,the serum S100βprotein and CCNI protein of the low-dose group and high-dose group were significantly lower than those of the control group,and the low-dose group was significantly lower than the control group.group was significantly lower than the high-dose group(P<0.05).The Ramsay score,NIHSS score,PTR and recovery time of the low-dose group and high-dose group at 24 hours after operation w

关 键 词：急性缺血性脑卒中 右美托咪定 取栓术 中枢神经特异性蛋白 富含半胱氨酸蛋白61 

分 类 号：R614[医药卫生—麻醉学] R743.3[医药卫生—外科学]