右美托咪定及七氟烷复合芬太尼对幕上脑肿瘤患者血清NSE、S-100β、MDA和SOD含量及脑氧供需平衡的影响

摘要

目的:分析右美托咪定及七氟烷复合芬太尼对幕上脑肿瘤患者脑氧供需平衡及代谢的影响.方法:采用前瞻性研究,将幕上脑肿瘤患者(90例)堆积分为2组,对照组在麻醉诱导前给予生理盐水,观察组给予右美托咪定.记录麻醉诱导前(T1)、气管插管时(T2)、硬脑膜切开时(T3)、肿瘤取出时(T4)、术毕(T5)、术后24 h(T6)患者脑氧供需平衡指标,即脑氧摄取率(CERO2)、颈内静脉球部血氧饱和度(SjvO2)、静脉血氧含量差(Ca-jvO2)、动脉血血氧含量(CaO2);对比各时间点患者脑能量代谢指标,即脑乳酸氧指数(LOI)、葡萄糖摄取率(GluER)、脑乳酸生成率(LacPR)水平.对比两组患者各时间点颈内静脉球部血清NSE、S-100β、MDA、SOD水平.结果:T3、T4、T5、T6时观察组CERO2、Ca-jvO2水平较对照组低,SjvO2水平较对照组高,均 为P＜0.05.观察组T4、T5时LacPR较对照组低,P＜0.05,其余指标对比无统计学差异,P＞0.05.T3、T4、T5、T6时观察组S-100β、NSE、MDA水平较对照组低,SOD水平较对照组高,均为P＜0.05.结论:右美托咪定能使幕上脑肿瘤患者围术期脑氧供需平衡得到改善,降低自由基水平和多种脑损伤特异性蛋白水平,有效保护脑组织.%Objective:To analyze the effects of dexmedetomidine and sevoflurane on the supply and demand bal-ance and metabolism of cerebral oxygen in patients with supratentorial brain tumor.Methods:A prospective study was conducted in which patients with supratentorial brain tumors (90 cases)were divided into 2 groups.The control group received saline before induction of anesthesia and the observation group received dexmedetomidine.Record the cere-bral oxygen supply-demand balance in patients before anesthesia induction (T1),tracheal intubation (T2),dura in-cision (T3),tumor removal (T4),surgery completion (T5),and postoperative 24 h (T6),namely brain oxygen up-take rate (CERO2),Blood oxygen saturation of the internal jugular vein (SjvO2),Poor venous oxygen content (Ca-jvO2),arterial blood oxygen content (CaO2).Comparison of patients at each time point of the brain energy metabo-lism index,the brain oxygenation index (LOI),glucose uptake rate (GluER),and brain lactate production rate (LacPR)levels.The levels of serum NSE,S-100β,MDA,and SOD in the jugular veins of the two groups at each time point were compared.Results:The levels of CERO2and Ca-jvO2in the observation group were lower than those in the control group at T3,T4,T5 and T6.The level of SjvO2was higher in the observation group than in the control group,both being P＜0.05.LacPR was lower in the observation group than in the control group at T4 and T5 (P＜0.05).There was no significant difference in other indicators between the observation group and the control group (P＞0.05).The levels of S-100β,NSE,and MDA in the observation group were lower than those in the control group at T3,T4,T5,and T6.SOD levels were higher in the observation group than in the control group,both being P＜0.05.Conclusion:Dexmedetomidine can improve perioperative cerebral oxygen supply and demand balance in patients with supratentorial brain tumors,reduce free radical levels and multiple brain injury-specific protein levels,and effectively protect brain tissue.