右美托咪定输注对颅内肿瘤手术患者脑脊液氨基酸水平的影响

摘要

Objective:To investigate the effects of dexmedetomidine on cerebrospinal fluid amino acid level of in-tracranial tumor paitents treated with surgery.Methods:All 146 patients with intracranial tumors were randomly divid-ed into two groups.Control group paitents were given equal volume of saline before anesthesia.Observation group pait-ents were given dexmedetomidine.T0 to T8,indicated before the induction of anesthesia,dura incision,excision of the tumor,the end of surgery,the patient awake extubation,postoperative 6h,12h after surgery and postoperative 24h.Glu (glutamic acid),Asp (aspartic acid)and inhibitory amino acid concentration GABA (r -aminobutyric acid)were measured at different time periods.HR and MAP were recorded from T0 to T3.Results:Glu,Asp,GABA,HR and MAP level of two groups at T0 were not different (P >0.05).Glu of observition group were (1.55 ±0.13)μmol/L, (1.67 ±0.18)μmol/L,(1.51 ±0.14)umol/L,(1.40 ±0.14)μmol/L,(1.30 ±0.14)μmol/L,(1.27 ±0.15)μmol/L from T3 to T8 .Asp of observition group were (2 .1 4 ±0 .1 9 )μmol /L,(2.44 ±0.26)μmol/L,(2.14 ±0.22)μmol/L,(1.97 ±0.19)μmol/L,(1.67 ±0.17)μmol/L,(1.45 ±0.15)μmol/L from T3 to T8.GABA of observition group were (12.69 ±0.74)μmol/L,(12.45 ±0.30)μmol/L,(13.68 ±0.29)μmol/L,(14.97 ±0.75)μmol/L,(15.53 ±0.78)μmol/L and (16.31 ±0.80)μmol/L from T3 to T8.Glu and Asp of observition group were significantly lower than control group.GABA observition group were significantly higher than control group.There were statistically difference(P <0.05).HR of observition group was significantly lower than control group from T1 to T3 (P <0.05).T1,T3 MAP of observition paitents was significantly lower than control group T1 and T3 (P <0.05). Conclusion:Dexmedetomidine can effectively reduce the concentration in cerebrospinal fluid of excitatory amino acids and inhibitory amino acid concentration increased,and facilitates hemodynamic stability.Thereby facilitating postoper-ative recovery.%目的：探讨右美托咪定对颅内肿瘤手术患者脑脊液中氨基酸的影响，减轻手术对脑组织的损伤。方法：选取颅内肿瘤手术患者146例，随机分为两组。麻醉前对照组给予同等容积生理盐水，观察组给予右美托咪定。分别以 T0－T8表示麻醉诱导前、切开硬脑膜时、切除肿瘤时、手术结束时、患者清醒、拔管时、术后6h、术后12h 以及术后24h，测定不同时间两组患者脑脊液中的 Glu（谷氨酸）、Asp（天门冬氨酸）以及抑制性氨基酸 GABA（r －氨基丁酸）的浓度，同时记录 T0－T3两组患者 HR（心率）和 MAP（平均动脉压）。结果：T0时两组患者 Glu、Asp、GABA、HR 以及 MAP 水平差别不大（P ＞0．05）。T3－T8时观察组患者 Glu 分别为（1．55±0．13）μmol／L、（1．67±0．18）μmol／L、（1．51±0．14）μmol／L、（1．40±0．14）μmol／L、（1．30±0．14）μmol／L、（1．27±0．15）μmol／L，Asp 分别为（2．14±0．19）μmol／L、（2．44±0．26）μmol／L、（2．14±0．22）μmol／L、（1．97±0．19）μmol／L、（1．67±0．17）μmol／L、（1．45±0．15）μmol／L，GABA 分别为（12．69±0．74）μmol／L、（12．45±0．30）μmol／L、（13．68±0．29）μmol／L、（14．97±0．75）μmol／L、（15．53±0．78）μmol／L 和（16．31±0．80）μmol／L，Glu、Asp 均明显低于对照组，GABA 明显高于对照组，两组比较差异有统计学意义（P ＜0．05）。T1－T3时观察组患者 HR 明显低于对照组（P ＜0．05）。T1、T3时 MAP 明显低于对照组（P ＜0．05）。结论：右美托咪定可以有效降低脑脊液中兴奋性氨基酸的浓度而升高抑制性氨基酸浓度，并有利于血流动力学稳定，从而利于患者术后康复。