右美托咪定联合利多卡因对脑肿瘤切除手术患者的脑保护效应

Brain protective effect of dexmedetomidine combined with lidocaine on patients undergoing brain tumor resection

目的观察右美托咪定联合利多卡因对脑肿瘤切除手术患者的脑保护机制。方法选取首次进行颅内肿瘤切除术的患者80例,随机均分为对照组(CON组)、利多卡因组(LIDO组)、右美托咪定组(DEX组)和右美托咪定联合利多卡因组(DEX+LIDO组),记录4组患者给药前(T_(1))及给药后1 h(T_(2))、2 h(T_(3))、3 h(T_(4))、术毕(T_(5))时点的平均动脉压(MAP)和心率(HR);于T_(1)、T_(2)、T_(3)、T_(4)及T_(5)时点抽取患者颈静脉球和外周动脉血5 mL进行血气分析,检测血糖和血浆乳酸水平,计算患者5个时间点的脑氧摄取率(CERO2)、葡萄糖摄取率(CERGlu)及脑颈静脉球-动脉血乳酸差值(Djv-alac);记录患者麻醉时间、苏醒时间和拔管时间,观察患者呛咳、躁动、惊厥等不良反应发生情况。结果4组患者T_(1)时MAP和HR比较,差异无统计学意义(P>0.05);T_(2)~T_(5)时,DEX+LIDO组患者MAP和HR均为最低(P<0.05);T_(1)时各组患者CERO2、CERGlu、Djv-alac比较,差异无统计学意义(P>0.05);T_(2)~T_(5)时,DEX+LIDO组CERO2、Djv-alac均为最低,而CERGlu最高(P<0.05);术后CON组患者苏醒时间和气管拔管时间最短,DEX+LIDO组最长,(P<0.05);DEX+LIDO组患者不良反应总发生率最低(P<0.05)。结论右美托咪定联合利多卡因麻醉用于脑肿瘤切除术,可改善患者脑组织氧代谢及降低不良反应。

Objective To observe the brain protective effect of dexmedetomidine combined with lidocaine on patients undergoing brain tumor resection.Methods Eighty patients who underwent the first intracranial tumor resection were randomly divided into control(CON group),lidocaine(LIDO group),dexmedetomidine(DEX group),and dexmedetomidine combined with lidocaine(DEX+LIDO group).Mean arterial pressure(MAP)and heart rate(HR)were recorded before administration(T_(1)),at 1 h(T_(2)),2 h(T_(3)),and 3 h(T_(4))after administration and at the end of surgery(T_(5))of 4 groups.At the time points T_(1),T_(2),T_(3),T_(4),and T_(5),5 mL jugular venous bulb blood and peripheral arterial blood was collected for blood gas analysis.Blood glucose and plasma lactate levels were measured.Cerebral extraction of oxygen(CERO2),glucose uptake rate(CERGlu),and lactic acid difference between cerebral jugular bulb blood and arterial blood(Djv-alac)were calculated at 5 time points.Durations of anesthesia,time to awakening and extubation time of the patients were recorded.The occurrence of adverse reactions such as cough,restlessness and convulsion were observed.Results There were no significant differences in MAP and HR at T_(1)among four groups(P>0.05).At T_(2)-T_(5),MAP,and HR of DEX+LIDO group were the lowest(P<0.05).At T_(1),there was no statistically significant differences in CERO2,CERGLu and Djv-alac among four groups(P>0.05).At T_(2)-T_(5),CERO2,and Djv-alac of DEX+LIDO group were the lowest,while its CERGlu was the highest among 4 groups(P<0.05).After surgery,the time to awakening and tracheal extubation time were the shortest in CON group,but the longest in DEX+LIDO group(P<0.05).The total incidence of adverse reactions in DEX+LIDO group was the lowest(P<0.05).Conclusion Dexmedetomidine combined with lidocaine for anesthesia in brain tumor resection can improve brain tissue oxygen metabolism and reduce adverse reactions.