咪达唑仑联合右美托咪定对颈动脉内膜剥脱术后患者神经功能的影响

Effect of midazolam combined with dexmedetomidine on neurologic function in patients following carotid endarterectomy

目的 探讨咪达唑仑联合右美托咪定对颈动脉内膜剥脱术后神经功能影响.方法 选择2016年3月~2019年2月于台州医院行颈动脉内膜剥脱术治疗的106例颈动脉狭窄患者作为观察对象,按随机数表法分成观察组和对照组,每组53例.对照组患者在术中实施常规麻醉,观察组患者给予咪达唑仑联合右美托咪定进行麻醉干预.对比两组患者颈动脉内膜剥脱术后神经功能、认知功能以及炎症反应.结果 观察组患者术后24 h血清BDNF、TGF-β1、5-HT、IGF-1、DA表达均高于对照组,但血清NSE表达低于对照组,差异有统计学意义(P<0.05);观察组患者术后1d、3d、7d认知功能MMSE评分高于对照组,差异有统计学意义(P<0.05);观察组患者术后24h的血清炎症因子IL-6、IL-13、TNF-α表达低于对照组,差异有统计学意义(P<0.05).结论 颈动脉内膜剥脱术中应用咪达唑仑联合右美托咪定能有效保护患者脑神经,抑制机体炎症反应,减少术后认知功能障碍发生,降低脑组织损伤.

Objective To investigate the effect of midazolam combined with dexmedetomidine on nerve function after carotid endarterectomy.Methods 106 patients with carotid stenosis treated by carotid endarterectomy in Taizhou Hospital between March 2016 and February 2019 were selected as the subjects.They were divided into observation group and control group using random number table method,with 53 cases in each group.The control group was provided with routine anesthesia while the patients in the observation group were given midazolam combined with dexmedetomidine for anesthesia intervention.The neurologic function,cognitive function and inflammatory response were compared between the two groups.Results The expression of serum BDNF,TGF-β1,5-HT,IGF-1 and DA at 24 h after the operation in the observation group was higher than those in the control group,but the expression of serum NSE in the observation group was lower than that in the control group,and the differences were statistically significant(P<0.05).The MMSE score of cognitive function at 1 d,3 d and 7 d after the operation in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).The expression of serum inflammatory factors IL-6,IL-13,TNF-αat 24 h after the operation in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion Midazolam combined with dexmedetomidine in carotid endarterectomy can effectively protect the brain nerves,inhibit the inflammatory reaction,reduce the occurrence of cognitive dysfunction and brain tissue damage.