右美托咪定对脊柱骨折并发脊髓损伤患者炎症因子及神经功能的影响

The Effect of Dexmedetomidine on the Inflammatory Factors and Neurological Function in Patients with Spinal Fracture and Spinal Cord Injury

目的:探讨右美托咪定对脊柱骨折并发脊髓损伤患者炎症因子及神经功能的影响。方法:回顾性选择本院122例脊柱骨折合并脊髓损伤患者为研究对象,采用随机数字表法分为对照组和观察组各61例。常规麻醉诱导前,观察组患者给予盐酸右美托咪定,对照组给予生理盐水。比较两组患者在麻醉诱导前(T0)、麻醉诱导后30 min(T1)、术后即刻(T2)、术后24 h(T3)及术后48 h(T4)血清中白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)、神经生长因子(NGF)、神经元特异性烯醇化酶(NSE)和S100B水平变化。结果:在T0和T1时间点,两组血清IL-6、TNF-α、S100B、NGF和NSE水平比较均无显著差异(P>0.05);在T2、T3和T4时间点,观察组血清IL-6、TNF-α、S100B、NGF和NSE水平均显著低于对照组(P<0.05);两组术后血清中IL-6和TNF-α水平均逐渐升高,且各个时间点显著高于本组术前(P<0.05)。两组血清中S100B、NGF和NSE水平在T2、T3和T4时间点均逐渐升高,差异均具有统计学意义(P<0.05)。术前所有患者血清IL-6、TNF-α与S100B、NGF和NSE均呈现显著正相关性,差异均具有统计学意义(P<0.05)。术后48 h,对照组和观察组不良反应发生率分别为21.31%和6.56%,组间比较差异显著(P=0.019)。结论:右美托咪定具有脊髓保护作用,可能与抑制血清炎症因子表达水平有关。

Objective:To investigate the effect of dexmedetomidine on the inflammatory factors and neurological function in patients with spinal fracture and spinal cord injury.Methods:122 patients with spinal fracture and spinal cord injury in our hospital were selected as the research objects and randomly divided into the control group and the observation group with 61 cases in each group.Before routine anesthesia induction,the observation group was given dexmedetomidine hydrochloride,and the control group was given normal saline.The serum levels of IL-6,TNF-α,nerve growth factor(NGF),neuron specific enolase(NSE)and S100B were compared between the two groups before anesthesia induction(T0),30 min after anesthesia induction(T1),immediately after operation(T2),24 h after operation(T3)and 48 h after operation(T4).Results:At the time point of T0 and T1,there was no significant difference in the serum levels of IL-6,TNF-α,S100B,NGF and NSEbetween the two groups(P>0.05).However,the serum levels of IL-6,TNF-α,S100B,NGF and NSE in the dexmedetomidine group were significantly lower than those in the control group at the time of T2,T3 and T4(P<0.05).The serum levels of IL-6 and TNF-αin both groups increased gradually and significantly higher than T0(P<0.05).The serum levels of S100B,NGF and NSE in both groups increased gradually and significantly higher than T0(P<0.05).The serum levels of IL-6 and TNF-αwere positively correlated with S100B,NGF and NSE in all patients,and the difference was statistically significant(P<0.05).The incidence of adverse reactions at 48 hours after operation in the control group and dexmedetomidine group were 21.31%and 6.56%,respectively.Compared with the control group,the incidence of adverse reactions in dexmedetomidine group was significantly lower(P=0.019).Conclusions:Dexmedetomidine improve neurologic function may related to inhibition inflammatory factor levels.