右美托咪定对静吸复合麻醉患者神经功能的保护作用及可能分子机制的探究

Protective effect of dexmedetomidine on neurological function of patients with intravenous inhalational anesthesia and the possible molecular mechanism

目的：研究右美托咪定对静吸复合麻醉患者神经功能的保护作用及可能的分子机制。方法：选择2012年7月~2015年12月我院接受静吸复合麻醉下手术的88例患者进行研究,DEX组接受右美托咪定联合静吸复合麻醉,对照组接受常规静吸复合麻醉,比较两组神经功能指标以及血清损伤性细胞因子和保护性细胞因子的含量、神经损伤所致高表达蛋白的含量、信号通路分子的含量。结果：DEX组动脉-颈内静脉球部血氧差[D（a-jv）O2]和脑氧摄取率（CERO2）水平以及血清髓鞘碱性蛋白（MBP）、神经元特异性烯醇化酶（NSE）、S100β含量显著低于对照组（P〈0.05）;DEX组血清神经生长因子（NGF）、脑源性神经营养因子（BDNF）含量显著高于对照组（P〈0.05）,血清核转录因子（NF-κB）、肿瘤坏死因子-α（TNF-α）、白介素-1β（IL-1β）、白介素-6（IL-6）、诱导型一氧化氮合酶（iNOS）、坍塌反应调节蛋白-2（CRMP-2）、电中性共同转运体1（NKCC1）和水通道蛋白4（AQP4）含量显著低于对照组（P〈0.05）。结论：右美托咪定对静吸复合麻醉患者神经功能具有保护作用,其分子机制包括增加保护性细胞因子的生成、抑制损伤性细胞因子的生成以及调节神经功能相关信号通路的激活。

Objective：To study the protective effect of dexmedetomidine on neurological function of patients with intravenous inhalational anesthesia and the possible molecular mechanism.Methods：A total of 88 cases of patients who received surgery under intravenous inhalational anesthesia in our hospital from July 2012 to December 2015 were selected for study,DEX group received dexmedetomidine combined with intravenous inhalational anesthesia,control group received conventional intravenous inhalational anesthesia,and then neurological function indexes as well as the contents of serum invasive cytokines and protective cytokines,the contents of nerve injury-caused highly expressed proteins and the contents of signaling pathway molecules were compared between two groups.Results：D（a-jv）O2and CERO2 levels as well as serum MBP,NSE and S100βcontents of DEX group were significantly lower than those of control group;serum NGF and BDNF contents of DEX group were significantly higher than those of control group,and serum NF-kB,TNF-α,IL-1β,IL-6,iNOS,CRMP-2,NKCC1 and AQP4contents were significantly lower than those of control group.Conclusions：Dexmedetomidine has protective effect on neurological function of patients with intravenous inhalational anesthesia,and its molecular mechanism includes increasing the generation of protective cytokines,inhibiting the generation of invasive cytokines and regulating the activation of neurological function-related signaling pathways.