右美托咪啶对老年脑肿瘤患者开颅手术后脑保护机制的研究

摘要

Objective:To explore the brain protection effect of dexmedetomidine(DEX) and the possible underlying mechanism on elderly patients with brain tumors in the tumor resection craniotomy. Methods: Sixty elderly patients underwent brain tumor resection were randomly divided into DEX group(n=30) and control group(n=30). The DEX group was given DEX before the operation, and the control group was given normal saline before the operation. Serum S100β, NSE, IL-6, TNF-α and SOD levels were measured before anesthesia induction (T1), cutting the du-ra mater (T5), removing the tumor (T6), surgery end time (T7), and 24 hours after the operation (T8). Results:There were no significant differences in S100β, NSE at T1, T5 between the two groups (P>0.05). The S100β and NSE levels in the DEX group at T6~T8 were statistically lower than those in the control group (P<0.05). There were no significant differences in IL-6, TNF-α and SOD at T1 between the two groups (P>0.05). The IL-6 and TNF-α levels in the DEX group were lower than those in the control group at T5~T8 (P<0.05), and the SOD level in the DEX group was higher than that in the control group at T5~T8 (P<0.05). Conclusion: The brain protection of DEX on the elderly patients with brain tumor in the surgery may be mediated by the reduction of S100β, NSE, TNF-α, IL-6 concentration in serum, and inhibition of the SOD activity.%目的：探讨右美托咪啶（DEX）对老年脑肿瘤患者开颅手术后脑损伤的保护机制。方法：60例行脑肿瘤手术切除的老年患者随机分成 DEX 组和对照组各30例，DEX 组术前静脉输注 DEX，对照组术前给予生理盐水。分别于诱导前（T1）、切开硬脑膜（T5）、取瘤（T6）、术毕（T7）、术后24 h（T8）采集血液标本，检测血清S100β、神经元特异性烯醇化酶（NSE）、白介素6（IL-6）、肿瘤坏死因子-α（TNF-α）、超氧化物歧化酶（SOD）水平。结果：在 T1、T5时点，患者血清中的 S100β、NSE 蛋白浓度水平差异无统计学意义（P>0.05），在 T6~T8时点，DEX 组血清中的 S100β、NSE 蛋白水平低于对照组（P<0.05）。在 T1时点，2组血清 IL-6、TNF-α蛋白水平和 SOD 活性差异无统计学意义（P>0.05），在 T5~T8时点，DEX 组血清 IL-6、TNF-α蛋白水平低于对照组（P<0.05），DEX 组 SOD 活性水平高于对照组（P<0.05）。结论：DEX 对老年脑肿瘤患者手术切除脑损伤的保护机制可能是有效降低血清中 S100β、NSE、TNF-α、IL-6浓度，减缓 SOD 活性水平的下降。