右美托咪定对神经外科手术患者围术期血清TNF-α和IL-6的影响及其临床观察

Effect of dexmedetomidine on serum TNF-α and IL-6 in neurosurgical patients during perioperation period and its clinical observation

目的：观察右美托咪定应用于神经外科手术患者对围术期血清TNF－α和IL－6的影响。方法选择天津市肿瘤医院于2014年1月～2014年8月收治的颅内动脉瘤患者60例作为研究对象，随机分为2组，每组30例，观察组于麻醉诱导前10 min泵注右美托咪定1μg／kg，结束后泵注右美托咪定0．4μg／（ kg？ h），对照组术前、术中给予生理盐水泵注，比较2组患者不同时刻血清TNF－α和IL－6水平。结果观察组应用右美托咪定后，血流动力学相关指标平均动脉压（ mean arterial pressure，MAP）及心率（ HR）更为平稳（P＜0．05）；观察组应用右美托咪定后，诱导后、切皮时、手术1h、手术结束时血清TNF－α水平分别为（1．32±0．35）、（1．42±0．54）、（1．52±0．67）及（1．57±0．63）μg／L，均低于对照组（P＜0．05）。诱导后、切皮时、手术1 h、手术结束时血清 IL－6水平分别为（69．64±13．54）、（72．43±16．75）、（76．32±16．93）及（77．42±15．75）μg／L，均低于对照组（P＜0．05）。结论右美托咪定应用于神经外科手术患者血流动力学更为稳定，且血清TNF－α和IL－6更低，有助于抗炎，具有重要临床价值。

Objective To observe the effects of dexmedetomidine on serum TNF-αand IL-6 in neurosurgical patients during perioperative period. Methods 60 cases patients with intracranial aneurysm treated in our hospital in January 2014 to August 2014 were selected as the research objects, and they were randomly divided into two groups with 30 cases in each group.Before induction, the observation group adopted 1μg/kg dexmedetomidine with 10 min infusion, then adopted 0.4μg/（ kg？ h） infusion of dexmedetomidine, and control group received saline infusion.Serum TNF-αand IL-6 levels in two groups were compared at different time.Results After application of dexmedetomidine, the related indexes of hemodynamics in observation group, mean arterial pressure （MAP） and heart rate （HR） were more stable （P〈0.05）.Serum levels of TNF-αat the time of after induction, skin incision operation, 1h operation in observation group were （1.32 ±0.35）, （1.42 ±0.54）, （1.52 ±0.67）, （1.57 ±0.63） μg/L, and were lower than those of control group, respectively （P〈0.05）.Serum levels of IL-6 at the time of after induction, skin incision operation, 1h operation in observation group were （69.64 ±13.54）, （72.43 ±16.75）, （76.32 ±16.93）, （77.42 ±15.75） μg/L and were lower than those of control group, respectively （P〈0.05）.Conclusion The hemodynamics after application of dexmedetomidine in patients with neurosurgery operation is more stable, and the serum TNF-αand IL-6 are lower, so it contributes to the anti-inflammatory and has important clinical value.