右美托咪定对烟雾病手术患者血浆中炎症因子的影响

The effect of dexmedetomidine on plasma inflammation factor in patients with moyamoya disease

目的探究右美托咪定对烟雾病患者血浆中炎症因子的影响。方法选取烟雾病患者82例,采用随机数字表分为对照组及观察组各41例。两组均行颞浅动脉-大脑中动脉搭桥+颞肌贴敷术+硬膜反转术治疗,观察组术中给予右美托咪定,对照组则给予等剂量生理盐水。记录两组气管插管时(T0)、右美托咪啶或生理盐水负荷量泵注结束时(T1)、打开硬脑膜时(T2)、打开硬膜后30 min(T3)、颞肌贴敷时(T4)、气管插管拔管时(T5)、气管插管拔管后30 min(T6)脑氧摄取率(CERO2),观察T0、T1、T5时细胞间粘附分子-1(ICAM-1)、白细胞介素-1β(IL-1β),比较T5、T6时躁动-镇静评分(RASS)、格拉斯哥昏迷评分(GCS)差异,并评估患者术后谵妄发生情况。结果两组T1~T6时CERO2均低于T0,且观察组CERO2均低于对照组,差异有统计学意义(P<0.05)。两组ICAM-1、IL-1β比较,均为T0<T1<T5,且T1、T5时,观察组ICAM-1、IL-1β低于对照组(P<0.05)。两组T5、T6时组内及组间GCS评分比较,差异无统计学意义(P>0.05);T6时,两组RASS评分均较T5时升高(P<0.05),且T5、T6时,观察组RASS评分低于对照组(P<0.05)。观察组术后谵妄发生率明显低于对照组(P<0.05)。结论右美托咪定能辅助稳定烟雾病术中血流动力学、降低脑代谢,减轻炎症反应,降低术后躁动及谵妄发生风险,具有良好脑保护作用。

Objective To investigate the effect of dexmedetomidine on plasma inflammation factor in patients with moyamoya disease(MMD).Methods Eighty-two MMD patients in our hospital from October 2019 to May 2020 were selected.The patients were divided into a control group and an observation group by using simple random grouping of random number table method,41 in each group.Both groups underwent the treatment of superficial temporal artery to middle cerebral artery bypass+temporal muscle patch+dural reverse transformation.The observation group was given dexmedetomidine intervention during operation while the control group was given the same dose of saline.Oxygen metabolism estimated by using cerebral oxygen extraction rate(CERO2)was recorded in both groups at tracheal intubation(T0),at the end of dexmedetomidine or saline load pumping(T1),at the opening of the dura mater(T2),at 30 min after opening the dura mater(T3),at temporal muscle patch(T4),at endotracheal intubation(T5)and at 30 min after endotracheal intubation(T6).The inflammatory response status estimated by measuring intercellular adhesion molecule-1(ICAM-1)and interleukin-1β(IL-1β)was observed at T0,T1,and T5.The sedation estimated by using Richmond agitation and sedation scale(RASS)and Glasgow coma scale(GCS)was compared at T5 and T6.The occurrence of postoperative delirium was also assessed.Results Compared with T0,CERO2 of both groups were decreased from T1 to T6(P<0.05).And the CERO2 of the observation group was lower than that of the control group.Comparison of ICAM-1 and IL-1βat each time point in the two groups showed that T0<T1<T5(P<0.05).At T1 and T5,the levels of ICAM-1and IL-1βin the observation group were lower than those in the control group(P<0.05).There was no statistically significant difference in the GCS score at T5 and T6 within the groups and between the two groups(P>0.05).At T6,the RASS scores of both groups were higher than those at T5,and at T5 and T6,the RASS score in the observation group was lower than that in the control group(P<0.05).The incidence rate of postoperative delirium in the observation group was significantly lower than that in the control group(P<0.05).Conclusion Dexmedetomidine can help stabilize the hemodynamics during MMD,reduce the cerebral metabolism,relieve the inflammatory response,and reduce the risk of postoperative agitation and delirium.It has a good brain protection.