右美托咪定对脑膜瘤切除术病人血清BDNF影响

EFFECT OF DEXMEDETOMIDINE ON SERUM BRAIN-DERIVED NEUROTROPHIC FACTOR IN PATIENTS UNDERGOING MENINGIOMA RESECTION

目的 探讨负荷剂量右美托咪定对脑膜瘤切除术病人血清脑源性神经营养因子(BDNF)含量及血流动力学参数的影响。方法 将40例择期行脑膜瘤切除术病人采用随机数字表法随机分为对照组(C组)和右美托咪定组(D组),每组20例。D组病人于麻醉诱导前10min静脉泵注右美托咪定1μg/kg,20min注射完毕;C组病人静脉泵注等容量生理盐水。记录病人术前和术后24h的简易精神状态量表(MMSE)评分;记录所有病人入手术室后(T0)、诱导前即刻(T1)、插管后1min(T2)、手术开始时(T3)、打开硬脑膜时(T4)、术毕即刻(T5)、术后10min(T6)的平均动脉压(MAP)及心率;分别于T0、T3、T4、T5、术后18h(T7)采集静脉血,测定血清中的BDNF含量。结果 C组病人术后MMSE评分显著低于术前(t=2.33,P<0.05),而D组病人术前、术后MMSE评分比较差异无显著意义(P>0.05)。D组病人T3~T6时的MAP和心率较T0时显著降低(F=5.93、7.72,P<0.01),且在T2时显著低于C组(t=2.60、4.26,P<0.05)。D组病人T3、T5时的血清BDNF含量显著高于C组(t=2.22、2.34,P<0.05)。结论 负荷剂量右美托咪定可以减小脑膜瘤切除术中血清BDNF的波动,有利于维持病人围手术期血流动力学参数平稳,具有一定的脑保护作用。

Objective To investigate the effect of load-dose dexmedetomidine on serum brain-derived neurotrophic factor(BDNF)and hemodynamics in patients undergoing meningioma resection. Methods A total of 40 patients undergoing elective meningioma resection were randomly divided into dexmedetomidine group(group D with 20 patients)and control group(group C with 20 patients).The patients in group D were given intravenous pumping of dexmedetomidine 1μg/kg at 10 minutes before anesthesia induction which was finished in 20 minutes,and those in group C were given intravenous pumping of an equal volume of normal saline.Mini-Mental State Examination(MMSE)score was recorded at 24 hours before and after surgery,and mean arterial pressure(MAP)and heart rate(HR)were recorded after the patient entered the operating room(T0),immediately before induction(T1),at 1 minute after intubation(T2),at the start of surgery(T3),after the opening of the dura mater(T4),immediately after surgery(T5),and at 10 minutes after surgery(T6).Venous blood samples were collected at T0,T3,T4,T5,and 18 hours after surgery(T7)to measure the serum level of BDNF. Results Group C had a significant reduction in MMSE score after surgery(t=2.33,P<0.05),while group D had no significant change in MMSE score after surgery(P>0.05).For group D,MAP and HR at T3-T6 were significantly lower than those at T0(F=5.93,7.72;P<0.01),with significantly lower MAP and HR than group C at T2(t=2.60,4.26;P<0.05).Group D had a significantly higher serum level of BDNF than group C at T3 and T5(t=2.22,2.34;P<0.05). Conclusion Load-dose dexmedetomidine can reduce the fluctuation of BDNF during meningioma resection and help to maintain stable hemodynamics in the perioperative period,thus exerting a certain cerebral protective effect.