右美托嘧啶对脊柱手术非急性期脆弱脑功能患者术后脑损伤的影响

Effects of dexmedetomidine on postoperative brain injuries in patients with non-acute phase fragile brain function after spinal surgery

目的观察右美托嘧啶对脊柱非急性期脆弱脑功能患者术后脑损伤的影响。方法前瞻性收集2016年12月至2017年5月全麻下行腰椎脊柱手术非急性期脆弱脑患者60例,ASAⅠ~Ⅲ级,采用随机数字表法分为2组(n=30):对照组(C组)和右美托咪定组(D组),每组30例。于麻醉诱导前30 min(T0)、手术结束时(T1)和术后第2d(T2)3个时点观察各指标及血浆中TNF-α、IL-6、IL-10、CRP的浓度变化,于术前1 d、术后2 d和术后1个月进行简易精神状态量表(MMSE)评分,并对2组患者术中全麻药物的用量、术后认知功能障碍的发生情况、住院时间进行比较。结果与T0比较,2组患者T2时TNF-α、IL-6、CRP明显升高(P<0.05),2组患者T1、T2时IL-10显著升高(P<0.05)。D组在T2时TNF-α、IL-6显著低于C组;D组在T2时IL-10浓度升高显著高于C组;术后2 d MMSE评分较术前明显降低,D组MMSE评分明显高于C组(P<0.05),术后2 d认知功能障碍发生率D组明显低于C组(P<0.05)。D组术中麻醉药瑞芬太尼、丙泊酚用量明显少于C组(P<0.05),2组住院时间差异无统计学意义(P>0.05)。结论非急性期脆弱脑功能患者行腰椎手术术中应用右美托咪定可降低术后早期认知功能障碍的发生,其发生机制可能与减少全麻药物的用量,TNF-α、IL-6降低和IL-10增加有关。

Objective To observe the effects of dexmedetomidine on on postoperative brain injuries in patients with non-acute phase fragile brain function after spinal surgery.Methods Sixty Patients with non acute phase fragile brain function(ASAⅠ~Ⅲ)who underwent lumbar spinal surgery under general anesthesia in our hospital from December 2016 to May 2017 were randomly divided into control group(n=30)and dexmedetomidine group(n=30).The changes of plasma levels of TNF-α,IL-6,IL-10,CRP at 30 min before anesthesia induction(T0),the end of operation(T1)and at the second day after operation(T2)were detected.Moreover the Mini Mental State Examination(MMSE)score was performed at 1 day before operation,at the second day and 1 month after operation.In addition the hospital stay,the amount of total general anesthetic drugs during surgery and incidence of postoperative cognitive dysfunction were observed and compared between the two groups.Results As compared with those at T0,the levels of TNF-α,IL-6 and CRP were significantly increased at T2 in both groups(P<0.05),and the levels of IL-10 were significantly increased at T1 and T2 in both groups(P<0.05).Moreover the levels of TNF-αand IL-6 at T2 in dexmedetomidine group were significantly lower than those in control group,however,the levels of IL-10 were significantly higher than those in control group(P<0.05).The MMSE scores at 2d after operation were significantly decreased,moreover the MMSE scores at 2d after operation in dexmedetomidine group were significantly higher than those in control group(P<0.05).In addition the incidence rate of cognitive dysfunction at 2d after operation in dexmedetomidine group was significantly lower than that in control group(P<0.05).The remifentanil and propofol dosages in dexmedetomidine group were significantly lower than those in control group(P<0.05).There was no significant difference in the length of staying in hospital between two groups(P>0.05).Conclusion The application of dexmedetomidine in lumbar vertebrae surgery in treatment of non-acute phase fragile brain function can reduce the incidence of postoperative cognitive dysfunction,its action mechanism may be related with the decrease of dosage of general anaesthesia drugs and levels of TNF-α,IL-6 As well as the increase of IL-10 levels.