右美托咪定联合芬太尼对高血压脑出血患者术后脑糖氧代谢及Toll样受体表达的影响

Effects of dexmedetomidine combined with fentanyl on cerebral glucose metabolism and Toll-like receptor expression in patients with hypertensive intracerebral hemorrhage

目的探讨右美托咪定联合芬太尼对高血压脑出血患者术后脑糖氧代谢及Toll样受体表达的影响。方法选取我院于2013年1月~2016年1月期间收治的120例行微创抽吸术治疗的高血压脑出血患者,依据随机原则分为观察组和对照组,各60例,观察组使用右美托咪定联合芬太尼麻醉,对照组采用丙泊酚联合芬太尼麻醉;比较两组患者血流动力学指标(MAP,SBP,DBP,PaO_2,PaCO_2)的变化;在麻醉前和术后1天、3天和5天时对所有患者进行简易智力状态测试(MMSE)和评分,比较两组患者的认知功能;监测并比较两组患者糖氧代谢指标(S_(jv)O_2,CEO_2,A-VGlu,AVDO_2,A-VPCO_2和A-VLac);检测并比较两组患者Toll样受体表达;对两组患者的不良反应率进行比较。结果对照组患者手术开始至术后24小时期间,心率,MAP,SBP和SBP均发生明显变化(P<0.05),观察组变化不明显(P>0.05),观察组T_2(钻孔时)、T_3(术后12小时)时刻的心率、T_2时刻的MAP、SBP和SBP均显著优于对照组(P<0.05);两组患者MMSE评分在术后1天和3天时,观察组均显著高于对照组(P<0.05);观察组术后糖氧代谢指标(S_(jv)O_2,CEO_2,A-VGlu,AVDO_2,A-VPCO_2和A-VLac)显著优于对照组(P<0.05);两组患者T_2(手术结束后12小时)、T_3(手术结束后12小时)、T_4(术后24小时)时刻的TLR2和TLR4水平较T_0(麻醉前)时刻明显升高(P<0.05),但与对照组比较,观察组T_2,T_3,T_4时刻的TLR2和TLR4水平均明显降低(P<0.05);两组不良反应率差异明显(P<0.05)。结论老年高血压脑出血患者术中应用右美托咪定联合芬太尼麻醉,术中及术后血流动力学稳定,呼吸抑制和术后认知功能障碍程度低。

Objective To investigate the effect of dexmedetomidine combined with fentanyl on expression of patients with cerebral oxygen and glucose metabolism and Toll like receptor in hypertensive cerebral hemorrhage.Methods 120 patients with routine treatment methods in our hospital from January 2013 to January 2016 were selected from the minimally invasive aspiration of hypertensive cerebral hemorrhage,according to randomly divided into observation group and control group,each of 60 cases,the observation group use of dexmedetomidine combined with fentanyl anesthesia,the control group using propofol combined with fentanyl anesthesia;hemodynamics were compared between the two groups index（MAP,SBP,DBP,PaO2,PaCO2）changes;mini mental state test for all patients before anesthesia and postoperative 1D,3D and 5D（MMSE）and score,compared two groups of patients with cognitive function were compared between the two groups;sugar metabolism of oxygen monitoring indicators（SjvO2,CEO2,and A-VGlu,AVDO2,A-VPCO2 and A-VLac）;the expression of the two groups were measured and compared in patients with Toll like receptor;to compare two groups of patients with adverse reaction rate.Resuts：The control group began operation to 24h after operation,heart rate,MAP,SBP and SBP changed significantly（P〈0.05）,the observation group did not change significantly（P〈0.05）,the observation group T2,T3 time heart rate,T2 time MAP,SBP and SBP were significantly better than the control group（P〈0.05）;the MMSE score of the two groups after 1 days and 3 days,the observation group were significantly higher than those in control group（P〈0.05）;oxygen glucose metabolism index of the patients in the observation group（SjvO2,CEO2,A-VGlu,AV-DO2,A-VPCO2and A-VLac）was significantly better than the control group（P〈0.05）;two T2,T3,T4 groups TLR2 and TLR4 levels when compared with T0 time increased significantly（P〈0.05）,but compared with the control group,the observation group T2,T3,TLR2 and TLR4 at T4 level was significantly reduced（P〈0.05）;the adverse reactions of the two groups had significant difference（P〈0.05）.ConclusionAnesthesia application of dexmedetomidine combined with fentanyl in patients with hypertensive cerebral hemorrhage in conclusion,stable hemodynamics during operation and postoperative respiratory depression and postoperative cognitive dysfunction in low level.