右美托咪定对重度颅脑创伤急救患者脑保护作用及其对炎症因子的影响

Neuroprotection Effect of Dexmedetomidine on Patients with Severe Brain Injury and its Influence on Inflammatory Factors

探讨右美托咪定在重型颅脑外创伤急救患者麻醉中的脑保护作用及其对炎症因子的影响。选择60例该院行急诊开颅手术的重型颅脑创伤患者,随机分为观察组和对照组,各30例。观察组于麻醉诱导前10 min给予右美托咪定1μg/kg,然后以0. 6μg/(kg·h)持续静脉泵注射。而对照组给予等容积的生理盐水。分别于术前(T1)、给药后(T2)、术后(T3)的检测颅内压、脑氧摄取率(CERO2),采用酶联免疫吸附试验(ELISA)检测血清中星形胶质源性蛋白(S100B)和肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)的表达水平。在T2、T3时间点,观察组的颅内压、CERO2、S100B、TNF-α、IL-6、CRP水平均明显低于对照组,差异有统计学意义(P <0. 05)。右美托咪定对于重型颅脑外伤的患者具有一定的脑保护作用,该作用可能与抑制炎症因子的表达有关。

To investigate the neuroprotection effect of dexmedetomidine on patients with severe brain injury and its influence on inflammatory factors,60 severe craniocerebral patients in routine emergency craniotomy were randomly divided into observation group and control group,30 cases in each. All patients were given peripheral venous access,monitoring vital signs,general anesthesia before tracheal intubation,routine anesthesia induction. The patients in observation group were given dexmedetomidine 1 μg/kg before anesthesia induction,and then injected with 0. 6 μg/( kg·h) 10 min continuous intravenous pump. Control group was given normal saline. Before operation( T1),after administration( T2) and after operation( T3),Codman intracranial pressure monitor was used to measure intracranial pressure dynamically respectively. Blood samples were collected through radial artery and internal jugular vein to check blood routine and blood gas analysis. Cerebral oxygen uptake rate( CERO2) was calculated according to Fick formula;the expression level of astroglial derived protein( S100 B),tumor necrosis factor-α( TNF-α),interleukin-6( IL-6),C-reactive protein( CRP) in serum were detected by enzyme-linked immunosorbent assay( ELISA). At the time of T1,there was no significant difference in intracranial pressure,CERO2 and S100 B between the two groups( P > 0. 05). The intracranial pressure,CERO2 and S100 B in observation group were significantly lower than those in control group at the time points of T2 and T3( P < 0. 05). At the time of T1,there was no significant difference in CRP,IL-6 and TNF-α between the two groups( P > 0. 05). CRP,IL-6 and TNF-α in observation group were significantly lower than those in control group at time points of T2 and T3( P < 0. 05). Dexmedetomidine has neuroprotection effect on patients with severe traumatic brain injury,which may be related to inhibiting the expression of inflammatory factors.