右美托咪定联合利多卡因对颅脑肿瘤手术患者神经功能、认知功能的影响

Effects of dexmedetomidine combined with lidocaine on nerve function and cognitive function in patients with craniocerebral tumor before and after surgical treatment

目的观察右美托咪定联合利多卡因对颅脑肿瘤手术患者神经功能、认知功能的影响。方法选择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4组:对照组(CON组)、利多卡因组(LIDO组),右美托咪定组(DEX组)和右美托咪定联合利多卡因组(DEX+LIDO组),每组20例。比较4组术前24 h、术后24 h脑脊液中神经肽类物质[精氨酸加压素(AVP)、催产素(OT)、β内啡肽(β-EP)]、神经功能、运动功能、认知功能、负面情绪及日常生活活动能力。结果4组术前24 h AVP、OT、β-EP、NFA评分、FMA评分、MMSE评分、SAS评分、HAMD评分、Barthel指数比较差异无统计学意义(P>0.05);DEX组、DEX+LIDO组术后24 h NFA评分、SAS评分、HAMD评分均低于CON组、LIDO组,AVP、OT、β-EP、FMA评分、MMSE评分、Barthel指数均高于CON组、LIDO组(P<0.05),且DEX+LIDO组NFA评分、SAS评分、HAMD评分低于DEX组,AVP、OT、β-EP、FMA评分、MMSE评分、Barthel指数高于DEX组(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能够有效促进患者术后神经功能恢复,提高脑脊液神经肽水平,同时改善患者认知功能、负面情绪和日常生活活动能力。

Objective To investigate the effects of dexmedetomidine combined with lidocaine on nerve function and cognitive function in patients with craniocerebral tumor before and after surgical treatment.Methods Eighty patients with craniocerebral tumors who underwent surgical treatment in our hospital were enrolled in the study,who were randomly divided into CON group,LIDO group,DEX group and DEX+LIDO group,with 20 cases in each group.The levels of neuropeptides(AVP,OT andβ-EP)in cerebrospinal fluid,and neurological function,motor function,cognitive function,anxiety,depression and daily living ability of patients were observed and compared between the four groups.Results At 24h before the operation,there were no significant differences in the levels of AVP,OT andβ-EP,and NFA scores,FMA scores,MMSE scores,SAS scores,HAMD scores and Barthel index among the four groups(P>0.05).At 24h after the operation,the NFA scores,SAS scores and HAMD scores in DEX group and DEX+LIDO group were significantly lower than those in CON group and LIDO group,however,the levels of AVP,OT,β-EP,and FMA scores,MMSE scores and Barthel index in DEX group and DEX+LIDO group were significantly higher than those in CON group and LIDO group(P<0.05).Moreover the NFA scores,SAS scores and HAMD scores in DEX+LIDO group were significantly lower than those in DEX group,but,the levels of AVP,OT,β-EP,and FMA scores,MMSE scores and Barthel index in DEX+LIDO group were significantly higher than those in DEX group(P<0.05).Conclusion The application of dexmedetomidine combined with lidocaine in craniocerebral surgery can effectively promote the recovery of neurological function,increase the levels of neuropeptides,improve the cognitive function,negative emotion and the daily living ability of patients with craniocerebral tumor after the surgery.