Medical Recapitulate

摘要

目的：探讨右美托咪定对全身麻醉下颅脑损伤患者的脑保护作用。方法选择2014年1月至2015年1月在山东省巨野县人民医院接受治疗的颅脑损伤患者60例，采用随机数字表法分为试验组和对照组，各30例。在相同的诱导麻醉下，试验组8 min 内静脉泵入右美托咪定负荷量0．5μg／kg，随后以0．1～0．4μg／（ kg・ h）维持泵注10 min；对照组注射相同剂量的0．9％ NaCl注射液。记录两组患者术前（T1）、给药后（T2）、术后（T3）的血流动力学指标（平均动脉压和心率）及血清S100B和糖分解烯醇酶（NSE）水平。结果试验组和对照组患者的平均动脉压在 T1、T2、T3分别为（96．3±2．1）、（87．2±2．3）、（88．3±3．5） mmHg（1 mmHg ＝0．133 kPa）和（97．2±2．3）、（94．2±1．4）、（90．1±2．3） mmHg，心率分别为（83．9±2．3）、（62．4±6．1）、（71．3±2．6）次／min 和（84．2±1．7）、（78．2±2．3）、（79．0±2．3）次／min，在T1时偏高，T2～T3时平均动脉压和心率逐渐趋于平稳，并且T2～T3时平均动脉压、心率低于T1时（P＜0．05）。试验组和对照组患者血清中S100B 在 T1、T2、T3水平值分别为（0．21±0．06）、（1．62±0．38）、（0．53±0．29）μg／L和（0．38±0．09）、（1．99±0．03）、（1．12±0．11）μg／L，NSE 在 T1、T2、T3水平值分别为（8．2±2．1）、（8．1±2．4）、（8．4±1．3）μg／L 和（8．3±2．0）、（9．4±1．8）、（9．5±1．2）μg／L，两组患者血清中S100B在T1～T2逐渐升高，T2～T3逐渐降低，试验组患者T2和 T3时的S100B和NSE 水平低于对照组（P＜0．05）。试验组患者术后1周的并发症发病率显著低于对照组[23．3％（7／30）比83．3％（25／30）]（ P ＜0．05）。结论右美托咪定可以显著降低颅脑损伤患者的平均动脉压、心率以及血清中 S100 B和 NSE 水平，对于全身麻醉下颅脑损伤患者颅脑保护具有积极的意义。%Objective To investigate the effects of dexmedetomidine on cerebral protection in patients with craniocerebral injury under general anesthesia .Methods Total of 60 patients with craniocerebral injury in Juye County People′s Hospital in Shandong Province from Jan.2014 to Jan.2015 were included in the study, and divided into a trial group(30 cases) and a control group(30 cases) according to the random number meth-od.Under the anesthesia induction,the trial group was given eight minutes infusion of dexmedetomidine at the load of 0.5 μg/kg,then maintained at 0.1-0.4 μg/( kg・ h) for 10 minutes;The control group was injected with the same dosage of 0.9% NaCl.The hemodynamic parameters of heart rate (HR),mean arterial pres-sure (MAP),the levels of neuron-specific enolase (NSE) and S100B were recorded at before operation(T1), medication stage(T2),and post operation(T3).Results The MAP of the trial group and control group at T1, T2,T3 were (96.3 ±2.1),(87.2 ±2.3),(88.3 ±3.5) mmHg and (97.2 ±2.3),(94.2 ±1.4),(90.1 ± 2.3) mmHg,the HR were (83.9 ±2.3),(62.4 ±6.1),(71.3 ±2.6) times/min and (84.2 ±1.7),(78.2 ± 2.3),(79.0 ±2.3) times/min,high at T1,gradually stabilized at T2-T3,significantly lower than T1 period (P<0.05).The S100B of the trial group and control group at T1,T2,T3 level were (0.21 ±0.06),(1.62 ± 0.38),(0.53 ±0.29) μg/L and (0.38 ±0.09),(1.99 ±0.03),(1.12 ±0.11) μg/L,NSE were (8.2 ± 2.1),(8.1 ±2.4),(8.4 ±1.3) μg/L and (8.3 ±2.0),(9.4 ±1.8),(9.5 ±1.2) μg/L,the level of S100B and NSE in the two groups in T1-T2 gradually increased,T2-T3 decreased,S100B and NSE serum lev-els of the trial group,at T2,T3 were significantly lower than the control group(P<0.05).The 1-week post-operative complications incidence of the trial group was significantly lower than the control group [23.3%(7/30) vs 83.3%(25/30)] ( P <0.05).Conclusion Dexmedetomidine can significantly reduce the MAP and HR in patients with craniocerebral injury,and serum S100B and NSE levels,therefore has positive signif-icance for brain protection of patients with craniocerebral injury under general anesthesia .