右美托咪定对缺血性脑卒中行颈动脉内膜剥脱术患者脑氧代谢的影响

Neuroprotective Effects of Dexmedetomidine on Cerebral Oxygen Metabolism in Carotid Endarterectomy of Patients with Cerebral Ischemic Stroke

目的观察右美托嘧定对颈动脉内膜剥脱术患者脑氧代谢及血清S100β和神经元特异性烯醇化酶(NSE)含量的影响。方法选择2015年3月至2017年4月46例美国麻醉医师协会(ASA)Ⅱ~Ⅲ级缺血性脑卒中择期行颈动脉内膜剥脱术患者,随机分为观察组(n=23)和对照组(n=23),观察组诱导前静脉注射右美托咪定1.0μg·kg-1,随后静脉泵入右美托咪定0.3μg·kg-1·h-1至手术结束前40 min,对照组同时注射等容量等速度的生理盐水。分别在颈动脉阻断前10 min(T1)、颈动脉开放后10 min(T2)、颈动脉开放后3 h(T3)和颈动脉开放后24 h(T4)采集颈内静脉球部和动脉血,测定各时点颈内静脉球部血氧分压(Pjv O2)和血氧饱和度(Sjv O2)、脑动—静脉血氧含量差(Ca-jv DO2)、血清S100β和NSE的含量。结果观察组Pjv O2和Sjv O2呈升高趋势,Ca-jv DO2呈降低趋势,与对照组比较差异有统计学意义(均P<0.05)。两组血清S100β和NSE的含量在T2、T3、T4均有升高,但对照组比观察组升高更为显著,差异有统计学意义(均P<0.05)。结论右美托嘧定能降低颈动脉内膜剥脱术患者脑氧代谢率,降低血清S100β和NSE的含量,具有一定的脑保护作用。

Objective To evaluate cerebral oxygen metabolism and observe the serum concentration of S100β protein and neuron specific enolase（NSE） in patients with cerebral ischemic stroke undergoing carotid endarterectomy with dexmedetomidine treatment. Methods Forty-six American Society of Anesthesiologists （ASA） II -III patients scheduled for carotid endarterectomy were randomly divided into the observation group（n =23） and control group（n =23） from March 2015 to April 2017. In observation group, a bolus of dexmedetomidine （ 1.0 μg . kg- 1 ） was administered before induction followed by 0.3 μg . kg- 1 . h -1 until the end of surgery. In control group, 0.9% saline infusion was given in the same volume at the same rate. The internal jugular venous bulbar zone partial pressure of oxygen （PjvO2 ）, oxyhemoglobin saturation （SjvO2） , arteriovenous oxygen content difference of brain （Ca-jvDO2 ） , the serum concentration of S100β and NSE were detected at 10 min before carotid clipped （T1） , 10 min after carotid released （ T2 ） , 3 h after carotid released（T3） ,24 h after carotid released （T4 ）. Results The PjvO2 and SjvO2 increased, however Ca-jvDO2 decreased in the observation group at different time,and compared with control group the difference were statistical significance （all P 〈 0.05）. The S100β and NSE were raised after carotid clipped, moreover itwas increased more significantly in control group than that of observation group （all P 〈 0. 05 ）. Conclusion Intraoperative infusion of dexmede- tomidine had neuroprotective effects, it could reduce cerebral oxygen metabolism, the serum concentration of S100β and NSE in patients with cerebral ischemicstroke undergoing carotid endarterectomy.