右美托咪定用于儿童颈总动脉外膜剥脱术的脑保护效应研究

Brain protective effect of dexmedetomidine during common carotid adventitial stripping in children

目的 探讨两种常用剂量右美托咪定(dexmedetomidine,DEX)对接受颈总动脉外膜剥脱术的脑性瘫痪患儿氧化应激指标、苏醒期躁动及脑保护的影响。方法 选取择期接受颈总动脉外膜剥脱术的脑性瘫痪患儿90例,按随机数字表法分为D1组(麻醉诱导前静脉注射DEX 0.4μg/kg),D2组(麻醉诱导前静脉注射DEX 0.8μg/kg),C组(麻醉诱导前静脉注射等量生理盐水),每组各30例。比较3组苏醒时间、拔管时间、心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)[入手术室时(T0)、插管时(T1)、手术开始时(T2)、术中颈动脉外膜剥脱时(T3)、手术结束时(T4)、拔管时(T5)]、血氧饱和度(oxygen saturation of blood,SO_(2))、苏醒期躁动情况[到达麻醉恢复室时(Tp0)、5 min(Tp5)、10 min(Tp10)、25 min(Tp25)、40 min(Tp40)]及脑保护评价指标。结果 D2组苏醒时间、拔管时间均长于D1、C组(P <0.05)。在T1~T5,D1、D2组HR、MAP均低于C组(P <0.05)。3组SO_(2)差异无统计学意义(P> 0.05)。3组血浆肾上腺素和皮质醇水平T4时均高于T0时(P <0.05),且D1、D2组均低于C组(P <0.05)。Tp0~Tp40,D1、D2组苏醒期躁动发生率均低于C组(P <0.05)。3组血清中枢神经特异性蛋白、神经元特异性烯醇化酶水平术后6 h、术后12 h均高于T0时(P <0.05),D1、D2组水平均低于C组(P <0.05)。结论 对脑性瘫痪患儿行颈总动脉外膜剥脱术,诱导前静脉注射0.4μg/kg和0.8μg/kg两种常用剂量DEX,均能显著降低苏醒期躁动发生率,并稳定HR、MAP、SO_(2)等生理指标,发挥脑组织保护作用。0.4μg/kg剂量在缩短苏醒、拔管时间等方面效应均显著优于0.8μg/kg。

Objective To compare and investigate the effects of two doses of dexmedetomidine(DEX) on oxidative stress indexes, waking agitation and brain protection in children with cerebral palsy undergoing common carotid artery exfoliation. Methods A total of 90 children with cerebral palsy who received common carotid artery exfoliation were randomly divided into group D1(inducible intravenous injection of DEX 0.4 μg/kg), group D2(inducible intravenous injection of DEX 0.8 μg/kg) and group C(inducible intravenous injection of normal saline), with 30 cases in each group.The wake time, extubation time, heart rate(HR) and mean arterial pressure(MAP)[at the time of entry(T0), at the time of intubation(T1), at the beginning of surgery(T2), at the time of intraoperative peeling of the carotid artery(T3), at the end of surgery(T4), at the time of extubation(T5)], oxygen saturation of blood(SO_(2)), agitation during the recovery period[immediately upon arrival in the recovery room(Tp0), 5 minutes(Tp5), 10 minutes(Tp10), 25 minutes(Tp25),40 minutes(Tp40)] and brain protective evaluation indexes of the three groups were compared. Results The wake time and extubation time of group D2 were longer than those of group D1 and C(P<0.05). In T1-T5, HR and MAP of group D1 and D2 were lower than those of group C(P<0.05). There was no significant difference in SO_(2)among the three groups(P>0.05). The plasma epinephrine and cortisol levels among the 3 groups at T4 were higher than those at T0(P<0.05), and those in group D1 and D2 were lower than those in group C(P<0.05). The incidence of restfulness in Tp0-Tp40, group D1 and D2 were lower than that in group C(P<0.05). The levels of serum central nerve specific protein and neuronspecific enolase among the 3 groups were higher than those in T0 at 6 h and 12 h after surgery(P<0.05), and those in group D1 and D2 were lower than those in group C(P<0.05). Conclusion Common carotid artery extirpation and intravenous administration of 0.4 μg/kg and 0.8 μg/kg DEX before induction can significantly reduce the incidence of agitation during recovery, stabilize physiological indexes such as HR, MAP and SO_(2), and play a protective role in brain tissue. The dosage of 0.4 μg/kg was significantly better than that of 0.8 μg/kg in shortening recovery time and extubation time.