右美托咪定联合利多卡因对颅脑肿瘤手术患者的脑保护作用  

Protective Effect of Dexmedetomidine Combined with Lidocaine on Brain in Patients Undergoing Craniocerebral Tumor Surgery

作　　者：孙庆田 SUN Qing-tian(Department of Anesthesiology,Hebei Traditional Chinese Medicine Orthopedics Hospital,Shijiazhuang,050000,China)

机构地区：[1]河北中医骨病医院麻醉科,石家庄050000

出　　处：《神经药理学报》2024年第5期42-46,共5页Acta Neuropharmacologica

摘　　要：目的:探讨右美托咪定联合利多卡因对颅脑肿瘤手术患者的脑保护作用。方法:河北中医骨病医院60例颅脑肿瘤手术患者按采用麻醉方案不同分利多卡因组、右美托咪定组以及联合组3组,每组20例。均采用罗库溴铵、舒芬太尼、丙泊酚及咪达唑仑麻醉诱导,右美托咪定组麻醉维持期持续输注0.4μg·kg^(-1)·h^(-1)右美托咪定;利多卡因组麻醉维持期持续输注2.0 mg·kg^(-1)·h^(-1)利多卡因;联合组麻醉维持期持续输注0.2μg·kg^(-1)·h^(-1)右美托咪定和1.0 mg·kg^(-1)·h^(-1)利多卡因。测定患者血清神经元特异性烯醇化酶(neuron-specificenolase,NSE)及S-100β、炎性因子水平,认知功能及神经功能。结果:给药前T_0,3组患者血清NSE及S-100β水平差异无统计学意义(P>0.05);T1、T2、T3时,利多卡因组血清NSE、S-100β水平较右美托咪定组低(P<0.05),联合组低于利多卡因组(P<0.05)。术前3组患者白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)水平及NFA评分差异无统计学意义(P>0.05);术后利多卡因组IL-6、TNF-α、hs-CRP水平及神经功能缺损量表(neurological function assessment,NFA)评分低于右美托咪定组(P<0.05),联合组低于利多卡因组(P<0.05)。术前3组患者简易智能精神状态评价量表(mini-mental state examination,MMSE)差异无统计学意义(P>0.05);术后利多卡因组MMSE评分较右美托咪定组高(P<0.05),联合组高于利多卡因组(P<0.05)。结论:利多卡因联合右美托咪定在颅脑肿瘤手术中能够显著降低神经损伤标志物及炎症因子水平,改善术后认知功能和神经功能,联合使用在脑保护方面具有潜在优势。Objective:To investigate the protective effect of dexmedetomidine combined with lidocaine on brain in patients undergoing craniocerebral tumor surgery.Methods:60 patients with craniocerebral tumor surgery were divided into lidocaine group,dexmedetomidine group and combined group according to different anesthesia schemes,20 cases in each group.Rocuronium bromide,sufentanil,propofol and midazolam were used for anesthesia induction.Dexmedetomidine group was given continuous infusion of 0.4μg·kg^(-1)·h^(-1) dexmedetomidine-during anesthesia maintenance.Lidocaine group was given continuous infusion of 2.0 mg·kg^(-1)·h^(-1) lidocaine during anesthesia maintenance.Dexmedetomidine 0.2μg·kg^(-1)·h^(-1) and lidocaine 1.0 mg·kg^(-1)·h^(-1) were continuously infused during anesthesia maintenance in the combined group.The levels of serum neuron-specific enolase(NSE),S-100β,inflammatory factors,cognitive function and neurological function were measured.Results:There was no significant difference in serum NSE and S-100βlevels among the three groups before administration(T_(0))(P>0.05).At T1,T2 and T3,the serum NSE and S-100βlevels in the lidocaine group were lower than those in the dexmedetomidine group(P<0.05),and the combined group was lower than the lidocaine group(P<0.05).There was no significant difference in the levels of IL-6,TNF-α,hs-CRP and NFA score among the three groups before operation(P>0.05).The levels of IL-6,TNF-α,hs-CRP and NFA score in the lidocaine group were lower than those in the dexmedetomidine group(P<0.05),and those in the combined group were lower than those in the lidocaine group(P<0.05).There was no significant difference in MMSE score among the three groups before operation(P>0.05).After operation,the MMSE score of the lidocaine group was higher than that of the dexmedetomidine group(P<0.05),and the combined group was higher than the lidocaine group(P<0.05).Conclusion:Lidocaine combined with dexmedetomidine can significantly reduce the levels of nerve injury markers and inflammatory

关 键 词：右美托咪定 利多卡因 颅脑肿瘤 手术 脑保护 

分 类 号：R969[医药卫生—药理学]