不同剂量右美托咪定对行乙状窦后微血管减压术的原发性三叉神经痛患者围术期血流动力学影响及脑保护作用

Effects of Different Doses of Dexmedetomidine on Perioperative Hemodynamics and Cerebral Protection of Patients with Idiopathic Trigeminal Neuralgia Undergoing Retrosigmoid Microvascular Decompression

目的探讨不同剂量右美托咪定对行乙状窦后微血管减压术(microvascular decompression,MVD)的原发性三叉神经痛(idiopathic trigeminal neuralgia,ITN)患者围术期血流动力学的影响及脑保护作用。方法选取2017年3月—2018年2月收治的60例行乙状窦后MVD的ITN,按照麻醉诱导前右美托咪定给药剂量的不同,分为高剂量组(n=21)、低剂量组(n=20)与对照组(n=19)。麻醉诱导前30 min,高剂量组与低剂量组均给予右美托咪定负荷剂量1.0μg/kg,后分别以0.7μg/(kg·h)、0.3μg/(kg·h)的速度进行维持,对照组则予等容量的0.9%氯化钠注射液。比较麻醉诱导前(T0)、麻醉诱导后(T1)、气管插管后即刻(T2)、手术结束即刻(T3)的血流动力学相关指标[收缩压(SBP)、舒张压(DBP)和心率(HR)]、脑氧代谢相关指标{脑氧摄取量(CEO 2)、动脉-颈内静脉球部血氧差[D(a-jv)O 2]}变化,检测T0、T3及手术结束后24 h(T4)时血清脑组织损伤标志物[S100β、神经元特异性烯醇化酶(NSE)]的水平,记录苏醒情况(意识恢复时间、自主呼吸恢复时间及拔管时间)及不良反应发生情况。结果与对照组比较,高剂量组、低剂量组T1、T2时HR、SBP、DBP及T1、T2、T3时CEO 2、D(a-jv)O 2水平均降低,差异有统计学意义(P<0.05或P<0.01);与低剂量组比较,高剂量组T1、T2时HR、SBP、DBP及T1、T2、T3时CEO 2、D(a-jv)O 2水平均降低,差异有统计学意义(P<0.05或P<0.01)。与对照组比较,高剂量组、低剂量组T3、T4时S100β、NSE水平下降,差异有统计学意义(P<0.01);与低剂量组比较,高剂量组T3、T4时S100β、NSE水平下降,差异有统计学意义(P<0.01)。3组意识恢复时间、自主呼吸恢复时间、拔管时间及不良反应总发生率比较差异无统计学意义(P>0.05)。结论高剂量右美托咪定更有利于稳定行乙状窦后MVD的ITN患者围术期血流动力学,改善脑氧代谢水平,降低血清脑损伤标志物含量,不影响患者麻醉苏醒时间,安全性较高。

Objective To explore the effects of different doses of Dexmedetomidine on perioperative hemodynamics and cerebral protection of patients with idiopathic trigeminal neuralgia(ITN)undergoing retrosigmoid microvascular decompression(MVD).Methods Sixty ITN patients who underwent retrosigmoid MVD and were admitted to the hospital during the period from March 2017 to February 2018 were enrolled.According to different administration doses of Dexmedetomidine before anesthesia induction,they were divided into high dose group(n=21),low dose group(n=20)and control group(n=19).At 30 min before the induction of anesthesia,the high dose group and low dose group were given 1.0μg/kg loading dose of Dexmedetomidine,followed by 0.7μg/(kg·h)and 0.3μg/(kg·h),respectively.The control group was given an equal volume of 0.9%normal saline injection.Before anesthesia induction(T0),after anesthesia induction(T1),immediately after tracheal intubation(T2)and immediately after end of surgery(T3),changes of hemodynamics related indexes[systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR)]and cerebral oxygen metabolism related indexes{cerebral extraction of oxygen(CEO 2),blood oxygenation difference of arterial-jugular veins bulb[D(a-jv)O 2]}were compared between the two groups.At T0,T3 and 24 h after surgery(T4),levels of serum brain tissue injury markers[S100β,neuron-specific enolase(NSE)]were detected.The recovery situations(consciousness recovery time,recovery time of spontaneous breathing,extubation time)and occurrence of adverse reactions were recorded.Results Compared with control group,levels of HR,SBP and DBP at T1 and T2,CEO 2 and D(a-jv)O 2 at T1,T2 and T3 were decreased in high dose and low dose groups(P<0.05 or P<0.01).Compared with low dose group,levels of HR,SBP and DBP at T1 and T2,CEO 2 and D(a-jv)O 2 at T1,T2 and T3 were decreased in high dose group(P<0.05 or P<0.01).Compared with control group,levels of S100βand NSE at T3 and T4 were decreased in high dose and low dose groups(P<0.01).Compared with low dose group,levels of S100βand NSE at T3 and T4 were decreased in high dose group(P<0.01).There were no significant differences in consciousness recovery time,recovery time of spontaneous breathing,extubation time and total incidence of adverse reactions among the three groups(P>0.05).Conclusion High-dose Dexmedetomidine is more conducive to stabling perioperative hemodynamics of ITN patients undergoing retrosigmoid MVD,improving level of cerebral oxygen metabolism,and reducing contents of serum brain injury markers,without influencing their recovery time from anesthesia,and with high safety.