右美托咪定对乳腺癌根治术后谵妄及S100β蛋白、NSE及TNF-α水平的影响

Effect of dexmedetomidine on postoperative delirium after radical mastectomy and levels of S100,NSE and TNF-α

目的探讨右美托咪定对乳腺癌根治术后谵妄及S100β蛋白、NSE及TNF-α水平的影响。方法选取2016年7月-2018年8月在我院行乳腺癌根治术的患者150例,根据随机数字表法分为两组,观察组患者在麻醉诱导后静脉输注右美托咪定0.5μg/kg·h至手术结束,对照组患者输注等量的生理盐水。比较两组患者的手术相关指标、术后不同时间点的谵妄发生率及S100β、NSE及TNF-α水平。结果两组患者的手术时间、麻醉时间、麻醉苏醒时间和术中出血量相比无统计学差异(P>0.05);观察组患者在T2和T3时间点的谵妄发生率显著低于对照组(P<0.05),T4时间点两组患者的谵妄发生率比较有统计学差异(P<0.05);两组患者T2、T3和T4时的S100β、NSE和TNF-α水平均显著高于T1时,且观察组患者T2、T3和T4时的S100β、NSE和TNF-α水平均显著低于对照组(P<0.05)。结论乳腺癌根治术患者麻醉诱导后静脉输注右美托咪定可显著降低患者术后谵妄的发生率,可能与其可改善患者血清S100β蛋白、NSE及TNF-α水平有关,且不影响患者的手术相关指标,值得临床借鉴。

Objective To investigate the effect of dexmedetomidine on postoperative delirium after radical mastectomy and levels of S100,NSE and TNF-α.Methods 150 patients who underwent radical mastectomy in our hospital from July,2016 to August,2018 were selected and divided into two groups according to the random number table method.Patients in the observation group were given intravenous injection of dexmedetomidine 0.5μg/kg·h after induction of anesthesia,while patients in the control group were given equal amount of saline.Operation-related indicators,postoperative delirium incidence at different time points,S100,NSE and TNF-αlevel were compared between the two groups.Results There were no statistically significant differences between the two groups in operation time,anesthetic time,anaesthetic awakening time and intraoperative blood loss(P>0.05).The incidence of delirium in the observation group at T2 and T3 time points was significantly lower than that in the control group(P<0.05),and there was significant difference in the incidence of delirium between the two groups at T4 time points(P<0.05).S100,NSE and TNF-αlevel at T2,T3 and T4 were significantly higher than those at T1,and S100,NSE and TNF-αlevel at T2,T3 and T4 were significantly lower in the observation group than in the control group(P<0.05).Conclusion Intravenous of dexmedetomidine after induction of radical mastectomy for breast cancer can significantly reduce the incidence of postoperative delirium in patients,which may be related to the improvement of serum S100,NSE and TNF-αlevels in patients,without affecting the surgical indicators of patients,which is worthy of clinical reference.