【摘要】：目的探討顱內(nèi)動(dòng)脈瘤患者術(shù)中給予右美托咪定對(duì)腦血流動(dòng)力學(xué)和腦氧代謝及對(duì)髓鞘堿性蛋白(MBP)、神經(jīng)元特異性烯醇化酶(NSE)和S100β水平的影響。方法選擇全麻下顱內(nèi)動(dòng)脈瘤手術(shù)患者60例,研究組30例在麻醉誘導(dǎo)前給予右美托咪定,對(duì)照組30例同期給予等量生理鹽水。分別于入室時(shí)(T0)、全身麻醉后(T1)、手術(shù)開(kāi)始時(shí)(T2)、阻斷供瘤動(dòng)脈時(shí)(T3)、阻斷顱內(nèi)動(dòng)脈瘤時(shí)(T4)、恢復(fù)供瘤動(dòng)脈時(shí)(T5)及手術(shù)結(jié)束時(shí)(T6)監(jiān)測(cè)并記錄患者心率(HR)、平均動(dòng)脈壓(MAP)、顱內(nèi)壓(ICP)、腦血流量(CBF)情況,并記錄患者自主呼吸恢復(fù)時(shí)間和Steward評(píng)分情況,同時(shí)血?dú)夥治鰴z測(cè)動(dòng)脈-頸內(nèi)靜脈球部血氧差〔D(a-jv)O2〕和腦氧攝取率(CERO2)水平,并于T0、T6、手術(shù)后6 h(T7)、手術(shù)后12 h(T8)和手術(shù)后24 h(T9)檢測(cè)血清MBP、NSE和S100β水平。結(jié)果研究組T1~T6時(shí)HR和MAP較T0時(shí)間點(diǎn)顯著降低(P0.05),且與對(duì)照組T0~T6時(shí)比較均有統(tǒng)計(jì)學(xué)差異(P0.05),且T1和T4時(shí)ICP和CBF均明顯低于對(duì)照組(P0.05),自主呼吸恢復(fù)時(shí)間顯著短于對(duì)照組,Steward評(píng)分明顯優(yōu)于對(duì)照組,并且研究組T2和T3時(shí)D(a-jv)O2和CERO2水平明顯低于T1,且同時(shí)低于對(duì)照組(P0.05),T9時(shí)MBP和NSE及T7~T9時(shí)S100β水平均明顯分別低于T6~T8和T6(P0.05)。結(jié)論對(duì)于顱內(nèi)動(dòng)脈瘤手術(shù)患者,右美托咪定具有維持腦血流動(dòng)力學(xué)和腦氧代謝穩(wěn)定,進(jìn)一步減少腦免受損傷的腦保護(hù)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.
【作者單位】： 海口市人民醫(yī)院麻醉科;
【基金】：海南省自然科學(xué)基金資助項(xiàng)目(No.2012-SZR-04-07 812170)
【分類號(hào)】：R614

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