右美托咪定在小儿肝脏手术中的应用效果

Application effect of Dexmedetomidine in pediatric liver surgery

目的探讨右美托咪定在小儿肝脏手术中的应用效果。方法选取2018年7月—2020年6月在湖南省儿童医院接受肝脏肿块切除术的患儿60例,按随机数字表法将其分为D组和P组,每组各30例,D组采用右美托咪定,P组采用丙泊酚。比较两组血流动力学指标、局部脑氧饱和度(rSCO_(2))及血清脑源性神经营养因子(BDNF)、S-100β、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)、超氧化物歧化酶(SOD)水平。结果两组心率(HR)及D组平均动脉压(MAP)各时间点比较差异均有统计学意义(均P<0.05)。P组T_(1)、T_(2)、T_(3)、T_(4)时间点MAP与T_(0)比较,差异均有统计学意义(均P<0.05)。D组T_(1)、T_(2)、T_(3)、T_(4)时间点的HR均低于同一时间点的P组;D组T_(2)、T_(3)、T_(4)时间点的MAP均低于同一时间点的P组;D组T_(2)、T_(3)时间点SpO_(2)均高于P组,差异有统计学意义(均P<0.05)。D组LrSCO_(2)在T_(1)时间点高于T_(0),T_(3)时间点低于T_(1),P组LrSCO_(2)在T_(2)、T_(3)时间点均低于T_(0)、T_(1),T_(4)时间点高于T_(3),差异有统计学意义(均P<0.05)。D组RrSCO_(2)在T_(1)时间点高于T_(0),在T_(2)、T_(3)时间点均低于T_(1),P组RrSCO_(2)在T_(2)、T_(3)时间点均低于T_(0)、T_(1),在T_(4)时间点高于T_(2)、T_(3),差异有统计学意义(均P<0.05)。D组T_(1)、T_(2)、T_(3)时间点的LrSCO_(2)、RrSCO_(2)均高于同一时间点的P组,差异有统计学意义(均P<0.05)。两组各时间点的BDNF水平比较差异均有统计学意义(均P<0.05)。D组S-100β水平除T_(2)与T_(3)及T_(3)与T_(4)时间点比较差异无统计学意义(P>0.05)外,其余各时间点比较差异均有统计学意义(均P<0.05)。P组S-100β水平在T_(2)、T_(3)、T_(4)时间点均高于T_(0)、T_(1),在T_(4)时间点高于T_(2)、T_(3),差异有统计学意义(均P<0.05)。D组T_(2)、T_(3)、T_(4)时间点的BDNF水平均高于同一时间点P组,S-100β水平均低于同一时间点P组,差异有统计学意义(均P<0.05)。两组IL-10、TNF-α、SOD各时间点比较差异均有统计学意义(均P<0.05)。D组T_(2)、T_(3)、T_(4)时间点的IL-10水平均低于同一时间点P组,D组T_(1)、T_(2)、T_(3)时间点的TNF-α水平均低于同一时间点P组,D组T_(3)、T_(4)时间点的SOD水平均低于同一时间点P组,差异有统计学意义(均P<0.05)。结论小儿肝脏手术中应用右美托咪定能够稳定患儿血流动力学,提高rSCO_(2),降低炎症反应和氧化应激反应。

Objective To investigate the application effect of dexmedetomidine in pediatric liver surgery.Methods A total of 60 children who underwent liver lumpectomy at Hu’nan Children’s Hospital from July 2018 to June 2020 were selected.According to random number table method,they were divided into group D and group P,with 30 patients in each group.Group D was treated with Dexmedetomidine,and group P was treated with Propofol.The level of hemodynamic indexes,regional cerebral oxygen saturation(rSCO_(2))and serum contents of brain-derived neurotrophic factor(BDNF),S-100β,interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)and superoxide dismutase(SOD)were compared between the two groups.Results There were statistically significant differences in heart rate(HR)between the two groups and mean arterial pressure(MAP)of group D at each time point(all P<0.05).The differences of the MAP at T_(1),T_(2),T_(3),T_(4)time points in group P compared with T_(0),with the statistically significant(all P<0.05).The HR of group D at T_(1),T_(2),T_(3),T_(4)time points were lower than those of group P at the same time point,the MAP of group D at T_(2),T_(3),T_(4)time points were lower than those of group P at the same time point,SpO_(2)in group D were higher than those in group P at T_(2),T_(3)time points,and the differences were statistically significant(all P<0.05).LrSCO_(2)in group D at time point T_(1)was higher than that at T_(0),and at time point T_(3)was lower than that at T_(1),LrSCO_(2)in group P at time points T_(2)and T_(3)were lower than those at T_(0)and T_(1),and at time point T_(4)was higher than that at T_(3),the differences were statistically significant(all P<0.05).RrSCO_(2)in group D at time point T_(1)was higher than that at T_(0),and at time point T_(2),T_(3)were lower than those at time point T_(1),RrSCO_(2)in group P at time points T_(2)and T_(3)were lower than those at T_(0)and T_(1),and at time point T_(4)was higher than that at T_(2),T_(3),the differences were statistically significant(all P<0.05).The LrSCO_(2)and RrSCO_(2)of group D at time points T_(1),T_(2)and T_(3)were higher than those of group P at the same time points,and the differences were statistically significant(all P<0.05).There were statistically significant differences in BDNF levels between the two groups at each time point(all P<0.05).There were no significant differences in S-100βlevel at T_(2)and T_(3),T_(3)and T_(4)time points in group D(P>0.05),but there were significant differences at other time points in group D(P<0.05).The levels of S-100βin group P at time points T_(2),T_(3),T_(4)were higher than those at time point T_(0),T_(1),and at time point T_(4)was higher than that at time points T_(2),T_(3),with statistical significance(all P<0.05).The levels of BDNF at T_(2),T_(3),T_(4)in group D were higher than those in group P at the same time point,and the levels of S-100βwere lower than those in group P at the same time points,with statistical significance(all P<0.05).There were significant differences in the time points of IL-10,TNF-αand SOD between the two groups(all P<0.05).The levels of IL-10 at time points T_(2),T_(3),T_(4)in group D were lower than those in group P at the same time points,the levels of TNF-αat time points T_(1),T_(2),T_(3)in group D were lower than those in group P at the same time points,and the levels of SOD at T_(3),T_(4)in group D were lower than those in group P at the same time points,with statistical significance(all P<0.05).Conclusion The application of Dexmedetomidine in pediatric liver surgery can stabilize hemodynamics,improve local cerebral oxygen saturation,and reduce inflammatory response and oxidative stress response.