右美托咪定复合七氟醚对脑出血继发性损伤的预防效果及神经保护机制分析

Preventive effect of dexmedetomidine combined with sevoflurane on secondary injury after intracerebral hemorrhage and its neuroprotective mechanism

目的观察右美托咪定复合七氟醚对脑出血继发性损伤的预防效果。方法采用巢式病例对照研究法,选择2020年1月至2021年12月泰州市人民医院神经外科收治的84例高血压脑出血患者为研究对象,接受右美托咪定复合七氟醚术中麻醉的患者作为右美七氟醚组(42例),将基线资料匹配的接受七氟醚术中麻醉的患者作为单纯七氟醚组(42例)。比较2组患者基础麻醉时(t_(0))、麻醉诱导后1 min(t_(1))、2 min(t_(2))、5 min(t_(3))和插管后1 min(t_(4))、5 min(t_(5))、10 min(t_(6))的血流动力学指标[心率(HR)、平均动脉压(MAP)]、术中生命体征指标(血管活性药使用次数、术中血压、手术时间、术中出血量、心动过缓发生率、补救事件发生率)、相关氧化应激产物指标[丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)]、神经递质指标[血管加压素(VAP)、神经肽Y(NPY)、天冬氨酸(Asp)]的差异。结果(1)右美七氟醚组在t_(0)~t_(6)时间点的HR、MAP均低于单纯七氟醚组,差异有统计学意义(P<0.05)。与同组t_(0)时间点比较,2组患者t_(1)~t_(6)时间点的HR、MAP趋于平稳,差异有统计学意义(P<0.05)。(2)2组患者的血管活性药使用次数、心动过缓发生率、术中血压、术中出血量、手术时间及补救事件发生率比较,差异均无统计学意义(P>0.05)。(3)术后1、7、10 d,右美七氟醚组SOD、GSH-Px含量均高于单纯七氟醚组,而MDA含量低于单纯七氟醚组,差异有统计学意义(P<0.05)。与同组术后1 d比较,右美七氟醚组术后7、10 d的SOD、GSH-Px含量依次下降,而MDA依次升高,差异有统计学意义(P<0.05)。(4)2组患者术后1 d的VAP、NPY、Asp指标比较,差异无统计学意义(P>0.05);术后7、10 d,右美七氟醚组VAP、NPY、Asp均低于单纯七氟醚组,差异有统计学意义(P<0.05)。与同组术后1 d比较,2组患者术后7、10 d的VAP、NPY、Asp指标均依次降低,差异有统计学意义(P<0.05)。结论右美托咪定复合七氟醚可改善高血压脑出血手术患者的血流动力学、氧化应激产物及神经递质水平,从而起到预防脑出血手术继发性损伤的作用。

Objective To observe the preventive effect of dexmedetomidine combined with sevoflurane on secondary injury after cerebral hemorrhage.Methods Using the nested case-control study method,84 hypertensive patients with cerebral hemorrhage admitted to the Neurosurgery Department of Taizhou People's Hospital from January 2020 to December 2021 were selected as the study objects.The patients who received dexmedetomidine combined with sevoflurane during operation were treated as the dextromethorphane group(42 cases),and the patients who received sevoflurane during operation matching the baseline data were treated as the simple sevoflurane group(42 cases).The hemodynamic indexes[heart rate(HR),mean arterial pressure(MAP)],intraoperative vital signs[number of vasoactive drugs used,intraoperative blood pressure,operation time,intraoperative bleeding volume,incidence of bradycardia,and incidence of rescue events]of the two groups of patients at baseline anesthesia(t_(0)),1 min(t_(1)),2 min(t_(2)),5 min(t_(3))after anesthesia induction,and 1 min(t_(4)),5 min(t_(5)),10 min(t_(6))after intubation were compared differences of related oxidative stress product indicators[malondialdehyde(MDA),superoxide dismutase(SOD),glutathione peroxidase(GSH-Px)],neurotransmitter indicators[vasopressin(VAP),neuropeptide Y(NPY),aspartic acid(Asp)].Results(1)HR and MAP in the dextromethorphane group were lower than those in the simple sevoflurane group at t_(0)-t_(6) time points(P<0.05).Compared with t_(0) time point of the same group,HR and MAP of patients in the two groups tended to be stable at t_(1)-t_(6) time points(P<0.05).(2)There was no significant difference between the two groups in terms of the number of vasoactive drugs used,the incidence of bradycardia,intraoperative blood pressure,intraoperative bleeding,operation time and the incidence of remedial events(P>0.05).(3)On the 1st,7th and 10th day after operation,the contents of SOD and GSH-Px in the dextromethorphane group were higher than those in the simple sevoflurane group,while the contents of MDA was lower than that in the simple sevoflurane group(P<0.05).Compared with the same group on the 1st day after operation,the contents of SOD and GSH-Px in the dextromethorphane group decreased successively on the 7th and 10th day after operation,while MDA increased in turn,with statistically significant difference(P<0.05).(4)There was no significant difference in VAP,NPY and Asp between the two groups 1st day after operation(P>0.05);At 7th and 10th day after operation,VAP,NPY and Asp in the dextromethorphane group were significantly lower than those in the simple sevoflurane group(P<0.05).Compared with the same group on the first day after operation,the VAP,NPY and Asp indexes of patients in the two groups decreased successively on the 7th and 10th day after operation(P<0.05).Conclusion Dextrmedetomidine combined with sevoflurane can improve hemodynamics,oxidative stress products and neurotransmitter levels in patients undergoing intracerebral hemorrhage surgery,thus preventing secondary injury after intracerebral hemorrhage surgery.