静脉泵注右美托咪定对颅脑手术患者炎性因子、脑氧代谢及认知功能的影响

Effect of Intravenous Dexmedetomidine on Inflammatory Factors,Cerebral Oxygen Metabolism and Cognitive Function in Patients Undergoing Craniocerebral Operation

目的分析静脉泵注右美托咪定应用于颅脑手术患者中,对其炎性因子、脑氧代谢、认知功能的影响。方法选取2018年1月~2019年1月在我院行颅脑手术的80例患者为研究对象,采用随机数字表法分为对照组和观察组,各40例。对照组术前给予丙泊酚、咪达唑仑、舒芬太尼、维库溴铵麻醉,观察组在对照组基础上于麻醉诱导前静脉泵注右美托咪定,观察比较两组麻醉前(T1)、麻醉后5 min(T2)、麻醉后30 min(T3)、麻醉后60 min(T4)时炎性因子[白介素6(IL-6)、超敏C反应蛋白(hs-CRP)]水平、术前24 h和术后24 h脑氧代谢指标[颈内动脉氧含量(CaO2)、脑氧代谢率(CERO2)、颈内静脉血氧饱和度(SjvO2)]、认知功能评分以及并发症发生情况。结果观察组T1时IL-6、hs-CRP与对照组比较,差异无统计学意义(P>0.05);观察组T2、T3、T4时IL-6、hs-CRP水平均低于对照组,差异有统计学意义(P<0.05);术前24 h观察组CaO2、CERO2、SjvO2与对照组比较,差异无统计学意义(P>0.05);观察组术后24 h CaO2低于对照组,CERO2、SjvO2均高于对照组,差异有统计学意义(P<0.05);观察组术后24 h认知功能评分高于对照组,差异有统计学意义(P<0.05);两组均未发生严重并发症。结论在颅脑手术患者中给予静脉泵注右美托咪定,有助于降低炎性因子水平,提高脑氧代谢,提高患者术后认知功能,降低受认知障碍的发生风险。

Objective To analyze the effects of intravenous dexmedetomidine on inflammatory factors,cerebral oxygen metabolism and cognitive function in patients undergoing craniocerebral surgery.Methods 80 patients who underwent craniocerebral operation in our hospital from January 2018 to January 2019 were enrolled in the study.They were randomly divided into the control group and the observation group,40 cases each.The control group received propofol,midazolam,sufentanil,and vecuronium anesthesia before operation.The observation group was given dexmedetomidine intravenously before anesthesia induction on the basis of the control group.Inflammatory factors[interleukin-6(IL-6),hypersensitive C-reactive protein(hs-CRP)before(T1),5 min after anesthesia(T2),30 min after anesthesia(T3),60 min after anesthesia(T4)]levels,cerebral oxygen metabolism index[CaO2,cerebral oxygen metabolism(CERO2),internal jugular venous oxygen saturation(SjvO2)],cognitive function scores,and 24 h after surgery complications.Results There was no significant difference in IL-6 and hs-CRP between the observation group and the control group(P>0.05).The levels of IL-6 and hs-CRP in the observation group were lower than those in the control group at T2,T3 and T4,there was statistical significance(P<0.05).There were no significant differences in CaO2,CERO2 and SjvO2 between the observation group and the control group at 24 h before operation(P>0.05).The CaO2 in the observation group was lower than that in the control group at 24 h after operation,and CERO2 and SjvO2 were higher than the control group,the difference was statistically significant(P<0.05);the cognitive function score of the observation group was higher than that of the control group at 24 h after operation,the difference was statistically significant(P<0.05);no serious complications occurred in either group.Conclusion Intravenous injection of dexmedetomidine in patients with craniocerebral surgery can help reduce inflammatory factor levels,increase cerebral oxygen metabolism,improve postoperative cognitive function,and reduce the risk of cognitive impairment.