右美托咪定在颅内动脉瘤手术中的脑保护作用

Neuroprotective effect of dexmedetomidine in the brain hemangioma surgery

目的探讨颅内动脉瘤手术中应用右美托咪定对S100β蛋白、神经元特异性烯醇化酶(neuron specific enolase,NSE)水平和血流动力学的影响。方法择期全身麻醉下行颅内动脉瘤手术患者60例,随机分为右美托咪定1组(观察1组)、右美托咪定2组(观察2组)和对照组各20例。观察1组10 min负荷剂量右美托咪定1μg/kg,然后以0.5μg/(kg·h)速度注射;观察2组10min负荷剂量右美托咪定0.5μg/kg,然后以0.3μg/(kg·h)速度注射;对照组静脉注射等剂量生理盐水。分别于入室(T0)、麻醉后(T1)、手术开始时(T2)、阻断供瘤动脉时(T3)、阻断动脉瘤时(T4)、恢复供瘤动脉时(T5)、手术结束时(T6)7个时间点测量患者心率、平均动脉压变化,于T0、T6、手术后6h(T7)、手术后12h(T8)、手术后24h(T9)检测血清S100β蛋白与NSE水平。结果观察1组与观察2组T1、T2、T3、T4、T5、T6时间点平均动脉压与对照组比较差异有统计学意义(P<0.05),观察1组与观察2组各时间点平均动脉压比较差异无统计学意义(P>0.05);观察1组与观察2组T2、T3、T4、T5、T6时间点心率较T0、T1时间点及对照组明显降低(P<0.05);观察1组与观察2组T6、T7、T8、T9时间点S100β蛋白、T9时间点NSE水平与对照组比较差异有统计学意义(P<0.05),观察1组与观察2组间比较差异无统计学意义(P>0.05)。结论右美托咪定在颅内动脉瘤手术中可维持血流动力学稳定性,降低S100β蛋白、NSE水平,有脑保护作用。

Objective To observe the effect of dexmedetomidine on concentrations and hemodynamics of S100β protein and neuron-specific enolase （NSE） in the brain hemangioma surgery. Methods Sixty patients, scheduled for brain hemangioma surgery under general anesthesia, were randomly divided into three groups： mexdetomidine group 1, mexdetomidine group 2 and control group, with 20 patients in each group. Mexdetomidine group 1 was intravenously injected 1 μg/kg mexdetomidine for 10 minutes, followed by 0. 5 μg/（kg· h） injection. Mexdetomidine group 2 was intravenously injected 0.5 μg/kg for 10 minutes followed by 0.3 μg/（kg · h） injection. Control group was given the same volume of normal saline. The heart rate and mean arterial pressure were recorded in all groups at 7 time points： before operation （T0）, after anesthesia （T2）, at the beginning of operation （T2）, when blocking the artery of intracranial aneurysm （T3）, when blocking the intracranial aneurysm （T4）, when restoring artery of intracranial aneurysm （T5）, and at the end of the surgery （T6）. The concentrations of S100β protein and NSE were detected at five time points： T0, T6, six hours after operation （T7） , 12 hours after operation （T8） and 24 hours after the operation （T9）. Results Compared with control group, the mean arterial pressures at T1, T2, T3, T4, T5 and T6 were significantly different in mexdetomidine groups （P （0.05）, and there were no significant difference between mexdetomidine group 1 and mexdetomidine group 2 （P〉0.05）. The heart rates at T2, T3, T4, T5 and T6 were lower than those at T0 and T1 in mexdetomidine groups, and lower than those in control group （P（0.05）. There were significant differences in the S100β protein concentrations at T6, T7, T8 and T9, and in NSE levels at T9 between mexdetomidine groups and control group （P〈 0.05）, and there were no signficant differences between mexdetomidine groups （P〉0.05）. Conclusion Dexmedetomidine can maintain hemodynamic stability and reduce the concentrations of S100β protein and NSE in the brain hemangioma surgery, and has neuroprotective effect.