右美托咪定对颅内动脉瘤手术患者脑血流代谢和脑保护作用

发布时间：2018-09-04 06:04

【摘要】：目的探讨颅内动脉瘤患者术中给予右美托咪定对脑血流动力学和脑氧代谢及对髓鞘碱性蛋白(MBP)、神经元特异性烯醇化酶(NSE)和S100β水平的影响。方法选择全麻下颅内动脉瘤手术患者60例,研究组30例在麻醉诱导前给予右美托咪定,对照组30例同期给予等量生理盐水。分别于入室时(T0)、全身麻醉后(T1)、手术开始时(T2)、阻断供瘤动脉时(T3)、阻断颅内动脉瘤时(T4)、恢复供瘤动脉时(T5)及手术结束时(T6)监测并记录患者心率(HR)、平均动脉压(MAP)、颅内压(ICP)、脑血流量(CBF)情况,并记录患者自主呼吸恢复时间和Steward评分情况,同时血气分析检测动脉-颈内静脉球部血氧差〔D(a-jv)O2〕和脑氧摄取率(CERO2)水平,并于T0、T6、手术后6 h(T7)、手术后12 h(T8)和手术后24 h(T9)检测血清MBP、NSE和S100β水平。结果研究组T1~T6时HR和MAP较T0时间点显著降低(P0.05),且与对照组T0~T6时比较均有统计学差异(P0.05),且T1和T4时ICP和CBF均明显低于对照组(P0.05),自主呼吸恢复时间显著短于对照组,Steward评分明显优于对照组,并且研究组T2和T3时D(a-jv)O2和CERO2水平明显低于T1,且同时低于对照组(P0.05),T9时MBP和NSE及T7~T9时S100β水平均明显分别低于T6~T8和T6(P0.05)。结论对于颅内动脉瘤手术患者,右美托咪定具有维持脑血流动力学和脑氧代谢稳定,进一步减少脑免受损伤的脑保护作用。
[Abstract]:Objective to investigate the effects of dexmetomidine on cerebral hemodynamics, cerebral oxygen metabolism and the levels of myelin basic protein (MBP), neuron-specific enolase (NSE) and S100 尾 in patients with intracranial aneurysms. Methods A total of 60 patients with intracranial aneurysms under general anesthesia were selected. 30 patients in the study group were given dexmetomidine before anesthesia induction, and 30 patients in the control group were given the same amount of normal saline at the same time. Heart rate (HR), mean arterial pressure (MAP),) was monitored and recorded at the time of entry (T0), after general anesthesia (T1), at the beginning of operation (T2), when the donor artery was blocked (T3), when the intracranial aneurysm was blocked (T4), when the donor artery was restored (T5) and at the end of the operation (T6). (ICP), cerebral blood flow (CBF), The recovery time of autonomic respiration and Steward score were recorded. Blood gas analysis was used to detect the levels of (D (a-jv O 2) and cerebral oxygen uptake rate (CERO2) in arterial-internal jugular venous bulb. The serum levels of MBP,NSE and S100 尾 were measured at T0 T6, 6 h after operation (T7), 12 h after operation (T8) and 24 h after operation (T9). Results the HR and MAP in the study group were significantly lower than those in the control group at T0 time point (P0.05), and there were significant differences between the study group and the control group in T0~T6 (P0.05). The ICP and CBF at T1 and T4 were significantly lower than those in the control group (P0.05), and the recovery time of spontaneous respiration was significantly shorter than that of the control group (P0.05). The score was significantly better than that in the control group. The levels of D (a-jv) O 2 and CERO2 at T2 and T3 in the study group were significantly lower than those in the control group (P0.05), and the levels of MBP, NSE and S100 尾 at T9 and T7~T9 in the control group were significantly lower than those in T6~T8 and T6, respectively (P0.05). Conclusion for patients undergoing intracranial aneurysm surgery, dexmetomidine can maintain the stability of cerebral hemodynamics and cerebral oxygen metabolism, and further reduce the brain protection from injury.
【作者单位】：海口市人民医院麻醉科;
【基金】：海南省自然科学基金资助项目(No.2012-SZR-04-07 812170)
【分类号】：R614

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