右美托咪定复合瑞芬太尼全身麻醉对帕金森综合征患者脑深部电刺激术中靶点定位及血清S-100β、NSE的影响

Effects of Dexmedetomidine Combined with Remifentanil General Anesthesia on Target Localization and Serum S-100βand NSE during Deep Brain Stimulation in Patients with Parkinson's Syndrome

目的探讨右美托咪定复合瑞芬太尼全身麻醉对帕金森综合征患者脑深部电刺激术(DBS)中靶点定位和血清中枢神经特异蛋白(S-100β)、神经元特异性烯醇化酶(NSE)的影响。方法选取2021年5月-2022年5月行DBS治疗的帕金森综合征95例,依据麻醉方法不同分组,将采用右美托咪定复合瑞芬太尼全身麻醉的48例作为研究组,采用利多卡因和罗哌卡因局部麻醉的47例作为对照组。比较2组手术时间、术中出血量、拔管时间、丘脑底核(STN)频率、STN记录长度、坐标误差、平均动脉压(MAP)、心率(HR)、Ramsay镇静评分、帕金森综合征评分量表运动评分(UPDRS)及血清S-100β、NSE水平。结果研究组手术时间短于对照组(P<0.05)。2组STN频率、STN记录长度和坐标误差比较差异无统计学意义(P>0.05)。切皮即刻、定位测试时和手术结束时,MAP和HR 2组均较术前1 h降低,且研究组低于对照组;Ramsay镇静评分2组均较术前1 h升高,且研究组高于对照组(P<0.05,P<0.01)。定位测试时和手术结束时,血清S-100β和NSE水平2组均较术前1 h和切皮即刻升高,但研究组低于对照组(P<0.05)。术后14 d,2组单侧和双侧开状态、关状态UPDRS均较术前降低(P<0.05)。结论帕金森综合征患者DBS中采用右美托咪定复合瑞芬太尼全身麻醉能获得良好靶点定位和手术效果,可缩短手术时间、提高镇静作用,且能有效抑制术中血清S-100β和NSE水平,对脑组织有一定保护作用。

Objective To explore the effect of Dexmedetomidine combined with Remifentanil general anesthesia on target localization and serum central nerve specific protein(S-100)and neuron specific enolase(NSE)during deep brain stimulation(DBS)in patients with Parkinson's syndrome.Methods A total of 95 patients with Parkinson's syndrome who were treated with DBS in our hospital from May 2021 to May 2022 were collected.Among them,47 patients were treated with local anesthesia.According to different anesthesia methods,48 patients that were given general anesthesia with Dexmedetomidine combined with Remifentanil were selected as the research group,and 47 patients that were given local anesthesia with Lidocaine and Ropivacaine were selected as the control group.The duration of operation,intraoperative blood loss,extubation time,subthalamic nucleus(STN)frequency,STN recording length,coordinate error,mean arterial pressure(MAP),heart rate(HR),Ramsay sedation score,unified Parkinson's disease rating scale motor score(UPDRS),serum S-100βand NSE level were compared between the two groups.Results The duration of operation of the research group was shorter than that of the control group(P<0.05).There was no significant difference in the frequency of STN,STN record length,and coordinate error between the research group and the control group(P>0.05).The MAP and HR of the research group immediately after skin incision,at the time of localization test,and at the end of the operation were lower than those at 1 h before operation,and lower in the research group than in the control group;Ramsay sedation score in both groups was higher than that at 1 h before operation,and higher in the research group than in the control group(P<0.05,P<0.01).The levels of serum S-100βand NSE in the research group at the time of localization test and the end of the operation were higher than those at 1 h before operation and immediately after skin incision,but lower in the research group than in the control group(P<0.05).The unilateral and bilateral open and closed UPDRS scores of the research group and the control group at 14 d after operation were lower than those before the operation(P<0.05).Conclusion Dexmedetomidine combined with Remifentanil general anesthesia has a significant effect on intraoperative target localization and surgical effect during DBS in patients with Parkinson's syndrome,which can shorten duration of operation,improve sedation,more effectively inhibit intraoperative serum S-100βand NSE levels,and have a certain protective effect on brain tissue.