右美托咪定对急性脑梗死动脉溶栓术患者围术期脑氧代谢和脑保护作用研究  

Study of dexmedetomidine on perioperative cerebral oxygen metabolism and cerebral protection in patients with acute cerebral infarction undergoing arterial thrombolysis

作　　者：阿里木江·司马义 瞿莉[2] 赵萱 徐桂萍[2] Alimujiang Simayi;QU Li;ZHAO Xuan;XU Guiping(College of Graduate,Xinjiang Medical University,Urumqi 830017,China;Department of Anesthesiology,the People′s Hospital of Xinjiang Uygur Autonomous Region,Xinjiang Clinical Research Center for Anesthesia Management,Urumqi 830000,China)

机构地区：[1]新疆医科大学研究生学院,乌鲁木齐830017 [2]新疆维吾尔自治区人民医院麻醉科,新疆麻醉管理临床医学研究中心,乌鲁木齐830000

出　　处：《新疆医科大学学报》2024年第4期559-563,569,共6页Journal of Xinjiang Medical University

基　　金：新疆维吾尔自治区自然科学基金项目(2022D01C143)。

摘　　要：目的探讨右美托咪定对急性脑梗死动脉溶栓术患者围术期脑氧代谢和脑保护作用。方法选取新疆维吾尔自治区人民医院2023年1-8月收治的62例经导管选择性脑动脉内介入溶栓术的急性脑梗死患者为研究对象。采用随机数字表法将患者分为对照组(n=30)和右美托咪定组(n=32)。两组患者均采用全身麻醉,右美托咪定组患者在麻醉诱导前以1.0μg/kg的负荷剂量静脉输注右美托咪定10 min,随后以0.6μg·kg^(-1)·h^(-1)的速度持续输注至手术结束。对照组持续输注等量生理盐水至手术结束。记录两组患者在麻醉前(T_(0))、麻醉诱导后5 min(T_(1))、手术开始后30 min(T_(2))、手术开始后60 min(T_(3))和拔管苏醒后10 min(T_(4))时的心率(HR)、平均动脉压(MAP)和局部脑氧饱和度(rScO_(2));于T_(0)时和术后2 d(T_(5))分别经桡动脉和颈内静脉球部采集血样1 mL,记录血红蛋白(Hb)、血氧饱和度(SaO_(2))、动脉血氧分压(PaO_(2))、颈静脉血氧饱和度(SjvO_(2))等指标,计算脑氧摄取率(CERO_(2))和动脉-颈静脉血氧含量差(Da-jvO_(2)),同时检测神经元特异性烯醇化酶(NSE)、S100β、神经生长因子(NGF)、脑源性神经营养因子(BDNF)、超氧化物歧化酶(SOD)和丙二醛(MDA)的水平。在T_(4-5)时,使用美国国立卫生研究院卒中量表(NIHSS)对两组患者的神经功能缺损情况进行评估。结果与T_(0)时比较,T_(1-3)时两组患者HR和MAP均显著降低,T_(1-4)时右美托咪定组HR和MAP均低于对照组(P<0.05);与T_(0)时比较,T_(1-3)时两组患者rScO_(2)均显著降低,T_(2-3)时右美托咪定组rScO_(2)显著高于对照组(P<0.05);T_(5)时两组患者SjvO_(2)高于T_(0)时,CERO_(2)和Da-jvO_(2)低于T_(0)时(P均<0.05)。与对照组相比,右美托咪定组SjvO_(2)明显升高,CERO_(2)和Da-jvO_(2)明显降低(P<0.05);与T_(0)时比较,T_(5)时两组患者NSE、S100β、BDNF、NGF水平均显著升高,T_(5)时右美托咪定组NSE和S100β水平均显著低于对照�Objective To investigate the effect of dexmedetomidine on perioperative cerebral oxygen metabolism and cerebral protection in patients with acute cerebral infarction undergoing arterial thrombolysis.Methods 62 patients with acute cerebral infarction were selected as the research objects,all of whom received selective intra-arterial thrombolysis from January to August 2023 in the hospital.The patients were randomly divided into 2 groups,where 30 patients were in the control group and 32 patients in the dexmedetomidine group.Both of the 2 groups were given general anesthesia.The patients in dexmedetomidine group received an intravenous infusion of dexmedetomidine 1.0μg/kg(infusion of 10 min)before the operation and maintained with 0.6μg·kg^(-1)·h^(-1)till the end of operation.The patients in control group received the same amount of normal saline.Heart rate(HR),mean arterial pressure(MAP)and regional cerebral oxygen saturation(rScO_(2))were recorded before anesthesia(T_(0)),5 min(T_(1)),30 min(T2)and 60 min after the operation(T_(3))and 10 min after extubation and recovery(T_(4)).Blood samples of 1 mL were respectively collected from radial artery and internal jugular veins bulb at T_(0)and postoperative 2 d(T_(5)),and the corresponding hemoglobin(Hb),oxygen saturation(SaO_(2)),arterial partial pressure of oxygen(PaO_(2)),jugular vein oxygen saturation(SjvO_(2))were recorded.Cerebral oxygen uptake rate(CERO_(2))and arterial-jugular oxygen difference(Da-jvO_(2))were calculated.Neuron-specific enolase(NSE),S100β,nerve growth factor(NGF),brain-derived neurotrophic factor(BDNF),superoxide dismutase(SOD)and malondialdehyde(MDA)were also measured.At T_(4-5),the National Institutes of Health Stroke Scale(NIHSS)was used to evaluate the neurological impairment of the 2 groups.Results HR and MAP in both groups were significantly lower at T_(1-3)than at T_(0),and HR and MAP at T_(1-4)were significantly lower in the dexmedetomidine group than in the control group(P<0.05).Compared with T_(0),rScO_(2)in both groups were dec

关 键 词：右美托咪定 脑梗死 脑氧代谢 脑保护 

分 类 号：R743.33[医药卫生—神经病学与精神病学]