右美托咪定用于颅脑损伤患者术后镇静对神经功能、炎症及氧化应激反应的影响

摘要

Objective:To study the effects of postoperative dexmedetomidine sedation on nerve function ,inflammation and oxidative stress in patients with craniocerebral injury .Methods:Patients who were admitted to ICU and needed sedation and analgesia after craniocerebral injury craniotomy in Huiya Hospital between June 2016 and October 2017 were selected as the research subjects and divided into the Dex group who received postoperative dexmedetomidine sedation and the control group who received postoperative midazolam sedation according to the history data .The levels of nerve markers and inflammation molecules in serum as well as the expression of oxidative stress molecules in peripheral blood were measured before surgery as well as 24 h and 48 h after surgery .Results:Compared with those before surgery ,UCH-L1 ,NSE ,GFAP ,sFkn ,CXCL12 , IL-1βand sICAM1 levels in serum as well as Nrf2 ,NQO1 ,HO1 ,NOX2 and NOX4 expression in peripheral blood of both groups decreased significantly whereas BDNF and NGF levels increased significantly 24 h and 48 h after surgery ,and UCH-L1 , NSE ,GFAP ,sFkn ,CXCL12 ,IL-1βand sICAM1 levels in serum as well as Nrf2 ,NQO1 ,HO1 ,NOX2 and NOX4 expression in peripheral blood of Dex group 24 h and 48 h after surgery were significantly lower than those of control group whereas BDNF and NGF levels were significantly higher than those of control group .Conclusion:Dexmedetomidine for postoperative sedation can be more effective than midazolam to improve the nerve function ,reduce the inflammation and oxidative stress in patients with craniocerebral injury .%目的:研究右美托咪定用于颅脑损伤患者术后镇静对神经功能、炎症及氧化应激反应的影响.方法:选择惠州市中大惠亚医院2016年6月~2017年10月因颅脑损伤开颅术后送入IC U并需要镇静镇痛的患者为研究对象,根据病史资料将其分为接受右美托咪定术后镇静的Dex组、接受咪达唑仑术后镇静的对照组.手术前及手术后24、48 h,测定血清中神经标志分子、炎症反应分子的含量及外周血中氧化应激分子的表达量.结果:与手术前比较,两组患者手术后24、48 h血清中UCH-L1、NSE、GFAP、sFkn、CXCL12、IL-1β、sICAM1的含量以及外周血中Nrf2、NQO1、HO1、NOX2、NOX4的表达量均显著降低,BDNF、NGF的含量均显著升高且Dex组患者手术后24、48 h血清中UCH-L1、NSE、GFAP、sFkn、CXCL12、IL-1β、sICAM1的含量以及外周血中Nrf2、NQO1、HO1、NOX2、NOX4的表达量均显著低于对照组,BDNF、NGF的含量均显著高于对照组.结论:右美托咪定用于颅脑损伤患者术后镇静能够较咪达唑仑更为有效地改善神经功能、减轻炎症及氧化应激反应.