右美托咪定预防颅内动脉瘤栓塞术患者全麻插管交感神经反应及对血清炎性因子水平的影响

Effects of dexmedetomidine in preventing the sympathetic nerve response during general anesthesia and on the inflammatory factors levels in patients undergoing intracranial aneurysm embolization

目的研究右美托咪定预防颅内动脉瘤栓塞术患者全麻插管交感神经反应的效果及对血清炎性因子水平的影响,探讨右美托咪定对颅内动脉瘤栓塞术患者脑保护的作用机制。方法选取全身麻醉行颅内动脉瘤栓塞手术患者80例,采用随机数字表法将患者随机分为对照组(C组)和右美托咪定组(D组),每组40例。麻醉诱导前10 min,D组经静脉输注右美托咪定1μg/kg,随后以0.4μg·kg^(-1)·h^(-1)的速率持续输注至手术结束前30 min,C组采用同样的方法静脉输注等容量的0.9%氯化钠溶液。记录患者入室平静休息3 min(T1)、气管内插管前即刻(T2)、插管后即刻(T3)、插管后3 min(T4)的舒张压、收缩压、心率,将患者麻醉诱导期间收缩压、舒张压、心率最大值和最小值的差值定义为波动值。于患者入室平静休息3 min(T1)、气管内插管前即刻(T2)、插管后即刻(T3)、插管后3 min(T4)、手术结束时(T5)、术后6 h(T6)、术后24 h(T7)取桡动脉血测定T1、T2、T3、T4时血浆中去甲肾上腺素(norepinephrine,NE)水平及T1、T5、T6、T7时血清中肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、神经元特异性烯醇化酶(NSE)、S100β水平。结果与C组比较,D组患者T3、T4时的收缩压、舒张压及心率均降低(P<0.05),收缩压、舒张压和心率的波动值均显著降低(P<0.05)。与T1时比较,2组T3、T4时血浆NE水平均升高(P<0.05),与C组比较,D组T3、T4时血浆NE水平均降低(P<0.05)。与T1时比较,2组T5-7时的血清TNF-α、IL-6、NSE和S100β水平均升高(P<0.05),与C组比较,D组T5-7时的血清TNF-α、IL-6、NSE和S100β水平均降低(P<0.05)。结论右美托咪定可以预防颅内动脉瘤患者全麻插管时的交感神经反应,使患者血流动力学更稳定,同时可以降低颅内动脉瘤栓塞术患者术后血清炎性因子的水平,减轻脑缺血再灌注损伤,发挥脑保护作用。

Objective To investigate the effects of dexmedetomidine in preventing the sympathetic nerve response during general anesthesia and on the inflammatory factors levels in patients undergoing intracranial aneurysm embolization.Methods Eighty patients with intracranial aneurysm who were treated by embolism operation in our hospital were enrolled in the study,who were randomly divided into control group(group C,n=40)and dexmedetomidine group(group D,n=40).The patients in group D were given dexmedetomidine 1μg/kg(initial dose)at 10min before anaesthesia induction,followed by continuous infusion at 0.4μg·kg^(-1)·h^(-1) until 30 min at the end of operation,however,the patients in group C were given the same volume of normal saline.The diastolic blood pressure(DBP),systolic blood pressure(SBP),and heart rate(HR)after 3-min quiet rest in the room(T1),immediately before endotracheal intubation(T2),immediately after intubation(T3),and 3min after intubation(T4),and the serum levels of norepinephrine(NE)at 3min after calm(T1),immediately before endotracheal intubation(T2),immediately after intubation(T3),and 3min after intubation(T4)as well as the serum levels of TNF-α,IL-6,NSE and S100βat T1,at the end of operation(T5),at 6h after operation(T6)and at 24h after operation(T7)were observed and compared between the two groups.Results As compared with those in control group,the levels of SBP,DBP,HR at T3,T4 in group D were significantly decreased(P<0.05).As compared with those at T1,the NE levels at T3,T4 in both groups were significantly increased(P<0.05).As compared with those at T1,the serum levels of TNF-α,IL-6,NSE and S100βat T5,T6,T7 in both groups were significantly increased(P<0.05).As compared with those in control group,the serum levels of TNF-α,IL-6,NSE and S100βat T5,T6,T7 in group D were significantly decreased(P<0.05).Conclusion Dexmedetomidine can inhibit the sympathetic response during intubation,stabilize the hemodynamic in patients with intracranial aneurysm undergoing interventional operation,moreover,which can reduce the serum levels of inflammatory factors after operation,and relieve cerebral ischemia reperfusion injury,so as to play protective effects on the brain.