【摘要】：目的探討顱內動脈瘤患者術中給予右美托咪定對腦血流動力學和腦氧代謝及對髓鞘堿性蛋白(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動脈瘤手術患者60例,研究組30例在麻醉誘導前給予右美托咪定,對照組30例同期給予等量生理鹽水。分別于入室時(T0)、全身麻醉后(T1)、手術開始時(T2)、阻斷供瘤動脈時(T3)、阻斷顱內動脈瘤時(T4)、恢復供瘤動脈時(T5)及手術結束時(T6)監(jiān)測并記錄患者心率(HR)、平均動脈壓(MAP)、顱內壓(ICP)、腦血流量(CBF)情況,并記錄患者自主呼吸恢復時間和Steward評分情況,同時血氣分析檢測動脈-頸內靜脈球部血氧差〔D(a-jv)O2〕和腦氧攝取率(CERO2)水平,并于T0、T6、手術后6 h(T7)、手術后12 h(T8)和手術后24 h(T9)檢測血清MBP、NSE和S100β水平。結果研究組T1~T6時HR和MAP較T0時間點顯著降低(P0.05),且與對照組T0~T6時比較均有統(tǒng)計學差異(P0.05),且T1和T4時ICP和CBF均明顯低于對照組(P0.05),自主呼吸恢復時間顯著短于對照組,Steward評分明顯優(yōu)于對照組,并且研究組T2和T3時D(a-jv)O2和CERO2水平明顯低于T1,且同時低于對照組(P0.05),T9時MBP和NSE及T7~T9時S100β水平均明顯分別低于T6~T8和T6(P0.05)。結論對于顱內動脈瘤手術患者,右美托咪定具有維持腦血流動力學和腦氧代謝穩(wěn)定,進一步減少腦免受損傷的腦保護作用。
[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】：海南省自然科學基金資助項目(No.2012-SZR-04-07 812170)
【分類號】：R614

【參考文獻】

相關期刊論文 前3條

1 鄒以席;黃方炯;;S100B蛋白作為腦損傷標記物的研究進展[J];中華實用診斷與治療雜志;2009年08期

2 張偉;張加強;孟凡民;馬媛媛;;不同負荷劑量右旋美托咪定對成人行清醒氣管插管的影響[J];中華實用診斷與治療雜志;2011年11期

3 賀勇,尤志s，

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