右美托咪定对重度子痫前期患者的脑保护及安全性研究

Study of neuroprotection and its safety of dexmedetomidine in patients with severe preeclampsia

目的:评价右美托咪定对重度子痫前期患者的脑保护作用及其安全性。方法:以60例重度子痫前期腰硬联合麻醉患者为研究对象,采用随机数字表法将患者分为右美托咪定组和对照组,每组30例,右美托咪定组胎儿娩出后10 min内于产妇静脉输注右美托咪定0. 5μg·kg-1,随后以0. 5μg·kg-1·h-1速率输注至术毕;对照组给予等容量生理盐水。于麻醉前(T1)、术毕(T2)、术后6 h(T3)、术后12 h(T4)及术后24 h(T5)检测两组患者血清中星形胶质细胞S100蛋白β亚型(S100β)蛋白及神经元特异性烯醇化酶(NSE)浓度,监测各时间点血流动力学及并发症发生情况,术前1 d,术后1、3 d进行简易智能精神状态量表(MMSE)评分。结果:与对照组比较,T3、T4、T5时右美托咪定组S100β蛋白浓度明显降低(P <0. 05);T4、T5时右美托咪定组NSE浓度明显降低(P <0. 05)。右美托咪定组术后头晕、视物模糊的持续时间较对照组明显缩短(均P <0. 05),低血压发生率及术后降压药物使用率较对照组明显降低(均P <0. 05);两组患者心动过缓、术后头痛持续时间、MMSE评分以及住院天数比较,差异均无统计学意义(均P> 0. 05)。结论:胎儿娩出后于产妇静脉输注右美托咪定可降低重度子痫前期患者血清S100β蛋白、NSE的浓度,减少围术期血压波动,降低并发症发生率,具有一定的脑保护作用。

Objective: To evaluate the neuroprotection and its safety of dexmedetomidine in patients with severe preeclampsia. Methods: Sixty patients with severe preelampsia scheduled for elective cesarean section under combined spinal-epidural analgesia were randomly divided into the dexmedetomidine group and the control group,30 cases each group. The dexmedetomidine group received a loading dose of dexmedetomidine 0. 5 μg·kg-1 at10 min after delivery of the fetus,followed by infusion at a rate of 0. 5 μg·kg-1·h-1 until the end of operation,while the control group were treated with equivalent normal saline. The levels of serum S100β and NSE of the patieuts in the two groups were recorded before the anesthesia( T1),at the completion of operation( T2),6 h after operation( T3),12 h after operation( T4) and 24 h after operation( T5),repectively. At the same time,complications and hemodynamic responses were detected. The cognitive function was assessed at 1 d before operation and 1,3 d after operation by mini-mental state examination( MMSE),repectively. Results: Compared with the control group,the level of S100β in the dexmedetomidine group at T3,T4,T5 time points were decreased( P < 0. 05). The level of NSE in the dexmedetomidine group at T4,T5 time points were lower than those of the control group( P < 0. 05). Compared with the control group,the lasting time of dizziness,blurred vision of the dexmedetomidine group were significantly shorter( P < 0. 05) and the occurrence of hypotension and the use of antihypertensive drugs were decreased( P < 0. 05). There were no significant differences in bradycardia,duration of postoperative headache,MMSE score and postoperative hospital stay( P > 0. 05). Conclusion: Intravenous infusion of dexmedetomidine after delivery of the fetus can reduce serum S100β protein and NSE levels in patients with severe preeclampsia, reduce perioperative blood pressure fluctuations and the incidence of complications.Dexmedetomidine can provide neuroprotection.