右美托嘧啶联合纳布啡用于脑膜瘤手术对患者术后认知功能的影响

Effect of Dexmedetomidine Combined with Nalbuphine in Meningioma Surgery on Postoperative Cognitive Function

目的探讨右美托咪定(dexmedetomidine,Dex)联合纳布啡在脑膜瘤手术中应用对患者炎症及术后认知功能的影响。方法选取2018年7月至2019年3月昆明医科大学第一附属医院行择期脑膜瘤切除术治疗的符合纳入标准的患者60例,随机分为Dex联合纳布啡组(DN组,n=30)和Dex组(D组,n=30)。DN组在切皮前5 min静脉注射盐酸纳布啡0.2 mg/kg,诱导前30 min予Dex1μg/kg泵注10 min后改为0.5μg/(kg·h),持续泵注至缝合硬脑膜前。D组相同方案给Dex。其余麻醉方案相同。结果DN组拔管后HR、MAP均较D组低(P<0.05),DN组住院时间明显缩短(P<0.05)。DN组在相同时刻IL-6、IL-10、TNF-α浓度较D组较低;同组术前比较,DN组IL-6、IL-10、TNF-α浓度升高较D组小。DN组术后6 h、24 h MMSE评分明显较D组高(P<0.05);与术前相比,DN组6 h MMSE评分明显较低(P<0.05),D组6 h、24 h简易精神量表(MMSE)评分明显较低(P<0.05)。结论Dex联合纳布啡对脑膜瘤切除术患者能更好的维持血流动力学指标,减轻患者炎症反应,对患者术后认知功能影响更小,缩短住院时间。

Objective To investigate the effect of dexmedetomidine(Dex)combined with nalbuphine in meningioma surgery on inflammation and postoperative cognitive function.Methods From July 2018 to March 2019,60 patients who underwent elective meningioma resection in the First Affiliated Hospital of Kunming Medical University and met the inclusion criteria were randomly divided into Dex combined with nalbuphine group(DN group,n=30)and Dex group(D group,n=30).In the DN group,nalbuphine hydrochloride 0.2 mg/kg was injected intravenously 5 minutes before the skin incision,and Dex was injected with a pump of 1μg/kg 30 minutes before induction,and then changed to 0.5μg(kg·h),and the pump was continued until meninges are sutured.Give Dex the same plan for Group D.The rest of the anesthesia scheme is same.Results After extubation,the HR and MAP in the DN group were lower than those in the D group(P<0.05),and the hospital stay in the DN group was significantly shorter(P<0.05).At the same time,the concentrations of IL-6,IL-10,and TNF-αin the DN group were lower than those in the D group;compared with the same group,the IL-6,IL-10,and TNF-αconcentrations in the DN group increased less than that in the D groupbefore the operation.The 6 h and 24 h MMSE scores in the DN group were significantly higher than those in the D group(P<0.05);compared with preoperatively,the 6 h MMSE score in the DN group was significantly lower(P<0.05),and the 6 h and 24 h simple mental scale in the D group(MMSE)score was significantly lower(P<0.05).Conclusions Dex combined with nalbuphine can better maintain hemodynamic indexes for patients undergoing meningioma resection,reduce the inflammatory response of the patients,have a smaller impact on the postoperative cognitive function of the patients,and shorten the hospital stay.