右美托咪定、甲苯磺酸瑞马唑仑与丙泊酚对脑出血手术患者麻醉效果及血清神经损伤标志物和神经功能的影响

Anesthetic effect of dexmedetomidine,remimazolam tosilate and propofol on patients with cerebral hemorrhage surgery and influence on nerve injury markers and neurological function

目的:探讨右美托咪定、甲苯磺酸瑞马唑仑与丙泊酚对脑出血手术麻醉效果及血清神经损伤标志物和神经功能的影响。方法:选取120例脑出血手术患者为研究对象,根据麻醉药物不同分为右美托咪定组(右美咪定麻醉)、甲苯磺酸瑞马唑仑组(甲苯磺酸瑞马唑仑麻醉)和丙泊酚组(丙泊酚麻醉),每组各40例。比较各组患者血流动力学指标[入手术室时(T0)、气管插管即刻(T1)、血肿清除时(T2)及手术结束时(T3)心率(HR)、收缩压(SBP)、舒张压(DBP)];术前、术后24 h及术后1周血清神经损伤标志物[神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)、中枢神经特异蛋白(S100β)]水平;术前、术后1个月、术后6个月神经功能[美国国立卫生研究院卒中量表(NIHSS)评分];不良反应发生情况。结果:各组患者各时点HR、SBP、DBP、CSI比较,差异无统计学意义(P>0.05);术后24 h,各组患者血清NSE、GFAP、S100β水平均高于术前(P<0.05),且右美托咪定组最高;术后1周血清NSE、GFAP、S100β水平低于术前,但右美托咪定组最高(P<0.05);术后1个月NIHSS评分较术前降低(P<0.05),且术后6个月进一步下降,但右美托咪定组最高(P<0.05);各组麻醉相关不良反应发生率比较,差异无统计学意义(P>0.05)。结论:右美托咪定、甲苯磺酸瑞马唑仑与丙泊酚在脑出血手术中均可维持麻醉效果,但甲苯磺酸瑞马唑仑与丙泊酚的神经功能保护作用更优。

Objective:To explore the anesthetic effect of dexmedetomidine,remimazolam tosilate and propofol on patients undergoing cerebral hemorrhage surgery and influence on nerve injury markers and neurological function.Methods:120 patients undergoing cerebral hemorrhage surgery were divided into dexmedetomidine group,remimazolam tosilate group and propofol group according to different anesthetic,with 40 cases in each group.The hemodynamic[heart rate(HR),systolic blood pressure(SBP)and diastolic blood pressure(DBP)]at the time of admission to operating room(T0),immediately after otracheal intubation(T1),at the time of hematoma clearance(T2)and at the end of surgery(T3),serum nerve injury markers[serum neuron specific enolase(NSE),glial fibrillary acidic protein(GFAP),central nerve specific protein(S100β)]before surgery,at 24 h and 1 w after surgery,neurological function[NIHSS score]before surgery,at 1 and 6 m after surgery and adverse reactions were compared between the groups of patients.Results:There were no statistical differences in HR,SBP,DBP and CSI among the groups at each time point(P>0.05).The levels of serum NSE,GFAP and S100β in the groups at 24 h after surgery were higher than those before surgery,and the highest levels were the dexmedetomidine group,and the levels at 1 week after surgery were lower than those before surgery,and the highest levels were the dexmedetomidine group(P<0.05).The NIHSS score in the groups was decreased at 1 month after surgery compared to before surgery,and was further reduced at 6 m after surgery,and the score in dexmedetomidine group was the highest(P<0.05).There were no statistically significant differences in the incidence rates of anesthesia-related adverse reactions among the groups(P>0.05).Conclusion:Three kinds of anesthetics can maintain the anesthetic effect during cerebral hemorrhage surgery,but remimazolam tosilate and propofol have better protective effect on neurological function.