右美托咪定对中老年颅脑肿瘤手术患者脑代谢、炎性因子及认知功能的影响  

Effects of dexmedetomidine on brain metabolism,inflammatory factors and cognitive function in middle-aged and elderly patients with brain tumor surgery

作　　者：崔崇英 王威 刘燕 王寒 李金矿[1] CUI Chongying;WANG Wei;LIU Yan;WANG Han;LI Jinkuang(Department of Anesthesiology of Zhongxiang People's Hospital,Zhongxiang City,Hubei Province,431900,China)

机构地区：[1]湖北省钟祥市人民医院麻醉科,湖北钟祥431900

出　　处：《蛇志》2025年第1期63-66,共4页Journal of Snake

摘　　要：目的分析右美托咪定对中老年颅脑肿瘤手术患者脑代谢、炎症因子和认知功能的影响。方法选择2022年5月至2023年9月在我院行手术治疗的70例颅脑肿瘤患者,按随机数字表法分为观察组(35例)和对照组(35例)。观察组麻醉诱导前静脉泵注右美托咪定,对照组给予等量生理盐水,两组均采用咪达唑仑、丙泊酚、瑞芬太尼、维库溴铵进行麻醉诱导,并以丙泊酚维持麻醉。比较两组患者术后30 min和1 d时的脑代谢指标[脑氧代谢率(CMRO_(2))、颈静脉球血氧饱和度(SjvO_(2))]以及术后第1、3天的炎症指标[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]水平和术后3 d的认知功能[谵妄、认知功能障碍(POCD)发生率]情况。结果术后30 min和1 d,观察组的CMRO_(2)均低于对照组,SjvO_(2)均高于对照组,差异均有统计学意义(均P<0.05)。术后1 d,观察组的TNF-α、IL-6水平均低于对照组,差异均有统计学意义(均P<0.05)。术后3 d,观察组的谵妄、PCOD发生率均低于对照组,差异均有统计学意义(均P<0.05)。结论右美托咪定可有效改善中老年颅脑肿瘤手术患者的脑氧代谢指标,抑制围术期炎症反应,并降低术后谵妄及认知功能障碍发生率,值得临床应用。Objective To analyze the effect of dexmedetomidine on brain metabolism,inflammatory factors and cognitive function in middle-aged and elderly patients with brain tumor surgery.Methods 70 patients with brain tumor who underwent surgery in our hospital from May 2022 to September 2023 were randomly divided into observation group and control group(35 cases in each group).The observation group was injected with dexmedetomidine intravenously before anesthesia induction,and the control group was given the same amount of normal saline.Then the two groups were successively injected with midazolam,propofol,remifentanil,vecuronium to induce anesthesia,and propofol to maintain anesthesia.The cerebral metabolic indexes[cerebral metabolic rate for oxygen(CMRO_(2)),jugular venous oxygen saturation(SjvO_(2))]at 30 min and 1 d after operation were compared between the two groups;Inflammation at 1 and 3 days after operation refers to the levels of serum markers[tumor necrosis factor-α(tnf-α),interleukin-6(IL-6)];Cognitive function[incidence of delirium and postoperative cognitive dysfunction(POCD)]at 3D after surgery.Results 30 min and 1 d after surgery,CMRO_(2) and SjvO_(2) in observation group were lower than those in control group,and the differences were statistically significant(all P<0.05).On 1 day after surgery,the levels of TNFαand IL6 in observation group were lower than those in control group,and the differences were statistically significant(all P<0.05).3 days after operation,the incidence of delirium and PCOD in observation group was lower than that in control group,with statistical significance(all P<0.05).Conclusion Dexmedetomidine can effectively improve the cerebral oxygen metabolism balance of middle-aged and elderly patients with brain tumor surgery,inhibit the perioperative inflammatory response,and reduce the incidence of postoperative delirium and cognitive dysfunction,which has clinical application value.

关 键 词：中老年患者 颅脑肿瘤手术 右美托咪定 脑代谢指标 炎症因子 认知功能 

分 类 号：R614[医药卫生—麻醉学] R739.41[医药卫生—外科学]