右美托咪定联合利多卡因对颅脑肿瘤手术患者的脑保护作用

Protective effects of dexmedetomidine combined with lidocaine on brain tissues in patients with craniocerebral tumor undergoing surgery

目的观察右美托咪定联合利多卡因对颅脑肿瘤手术患者的脑保护作用。方法选择在张家口市第一医院神经外科择期行首次颅内幕上肿瘤切除术患者80例,随机分为CON组(对照组)、LIDO组(利多卡因组)、DEX组(右美托咪定组)和DEX+LIDO组(右美托咪定联合利多卡因组),每组20例。比较2组给药前(T0)、给药后1 h(T1)、2 h(T2)、3 h(T3)和术毕(T4)时生命体征[平均动脉压(MAP)、心率(HR)]、脑氧代谢指标[颈内静脉球部血氧饱和度(SjvO2)、脑动脉-静脉血氧含量差(Da-jvO2)、脑氧摄取率(CERO2)]、脑损伤指标[神经元特异性烯醇化酶(NSE)、S-100β]变化及术后恢复情况、不良反应发生情况。结果4组T0时MAP、HR、SjvO2、Da-jvO2、CERO2、NSE、S-100β比较差异无统计学意义(P>0.05),DEX组、DEX+LIDO组T1~T4时MAP、HR、Da-jvO2、CERO2、NSE、S-100β均低于CON组、LIDO组,SjvO2均高于CON组、LIDO组,差异有统计学意义(P<0.05),且DEX+LIDO组T1~T4时MAP、HR、Da-jvO2、CERO2、NSE、S-100β均低于DEX组,SjvO2均高于DEX组,差异有统计学意义(P<0.05)。DEX组、DEX+LIDO组拔管时间、苏醒时间均长于CON组、LIDO组,不良反应发生率均低于CON组、LIDO组,差异有统计学意义(P<0.05),且DEX+LIDO组拔管时间、苏醒时间均长于DEX组,不良反应发生率低于DEX组,差异有统计学意义(P<0.05)。结论颅脑肿瘤手术中应用右美托咪定联合利多卡因具有一定脑保护作用,能够改善患者脑氧代谢,有利于患者术后恢复,且不良反应发生率低。

Objective To investigate the protective effects of dexmedetomidine combined with lidocaine on brain tissues in patients with craniocerebral tumor undergoing surgery.Methods A total of 80 patients with craniocerebral tumors who underwent surgical treatment were enrolled in the study,who were randomly divided into control group(CON group),LIDO group(lidocaine medication),DEX group(dexmedetomidine medication)and DEX+LIDO group(dexmedetomidine+lidocaine),with 20 cases in each group.The levels of MAP,HR,SjvO2,Da-jvO2,CERO2,NSE and S-100βbebore medication(T0),at 1h(T1),2h(T2),3h(T3)after medication and at the end of operation(T4),and the postoperative recovery status and the incidence of adverse reactions were observed and compared between the two groups.Results There were no significant differences in the levels of MAP,HR,SjvO2,Da-jvO2,CERO2,NSE and S-100βat T0 among the four groups(P>0.05).The levels of MAP,HR,Da-jvO2,CERO2,NSE and S-100βduring T1~T4 in DEX group and DEX+LIDO group were significantly lower than those in CON group and LIDO group,however,the SjvO2 levels in DEX group and DEX+LIDO group were significantly higher than those in CON group and LIDO group(P<0.05).Moreover the levels of MAP,HR,Da-jvO2,CERO2,NSE and S-100βduring T1~T4 in DEX+LIDO group were significantly lower than those in DEX group,and the SjvO2 levels in DEX+LIDO group were significantly higher than those in DEX group(P<0.05).And the recovery time and extubation time in DEX group and DEX+LIDO group were significantly longer than those in CON group and LIDO group,and the incidence rates of adverse reactions in DEX group and DEX+LIDO group were significantly lower than those in CON group and LIDO group(P<0.05).In addition the recovery time and extubation time in DEX+LIDO group were significantly longer than those in DEX group,and the incidence rates of adverse reactions in DEX+LIDO group were significantly lower than those in DEX group(P<0.05).Conclusion The application of dexmedetomidine combined with lidocaine in craniocerebral tumor surgery has certain protective effects on brain in patients undergoing surgery,which is beneficial to improve patients’cerebral oxygen metabolism and promote postoperative recuperation of patients,and decrease the incidence rate of adverse reactions.