高渗盐水联合右美托咪定对重型颅脑损伤患者神经炎症因子水平的影响

Effect of hypertonic saline combined with dexmedetomidine on levels of neuroinflammatory factors in patients with craniocerebral injury

目的本研究探讨3%高渗盐水联合右美托咪定对重型颅脑损伤患者血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、神经元特异性烯醇化酶(NSE)及中枢神经特异蛋白(S100B)水平的抑制作用,为重型颅脑损伤患者的治疗提供了新的思路和方法。方法前瞻性研究选取2022年9月至2023年8月揭阳市人民医院神经外科收治的58例颅脑损伤患者为研究对象,采用随机、单盲法分为对照组和观察组。对照组采用甘露醇与其他镇静镇痛药物进行基础治疗,观察组在对照组的基础上加用3%高渗生理盐水及右美托咪定进行强化治疗。在伤后12 h(T_(1))、24 h(T_(2))、48 h(T_(3))和72 h(T_(4))测定血清IL-6、TNF-α、NSE及S100B水平。组间比较采用t检验、χ^(2)检验。结果观察组患者在T_(2)、T_(3)和T_(4)时刻的血清IL-6分别为(276.11±18.64)ng/L、(165.07±15.32)ng/L、(126.07±16.15)ng/L,TNF-α分别为(1.27±0.21)ng/L、(1.22±0.25)ng/L、(0.78±0.15)ng/L,NSE分别为(16.74±3.51)μg/L、(19.07±4.91)μg/L、(14.97±2.21)μg/L,S100B分别为(0.47±0.15)μg/L、(0.56±0.23)μg/L、(0.32±0.16)μg/L;对照组患者在T_(2)、T_(3)和T_(4)时刻的血清IL-6分别为(315.23±19.54)ng/L、(199.05±16.16)ng/L、(141.02±17.98)ng/L,TNF-α分别为(1.47±0.25)ng/L、(1.45±0.22)ng/L、(0.91±0.19)ng/L,NSE分别为(20.17±3.21)μg/L、(24.17±5.61)μg/L、(17.06±2.98)μg/L,S100B分别为(0.67±0.28)μg/L、(0.87±0.32)μg/L、(0.47±0.13)μg/L。两组比较差异均有统计学意义(均P<0.05)。结论3%高渗盐水联合右美托咪定可抑制重型颅脑损伤患者神经炎症因子水平的表达,减轻继发性脑损伤。

Objective To investigate the inhibitory effects and therapeutic efficacy of 3%hypertonic saline combined with dexmedetomidine on the levels of serum interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α),neuron-specific enolase(NSE),and central nervous system-specific protein(S100B)in patients with severe craniocerebral injury,and to provide new insights and methods for the treatment of patients with severe craniocerebral injury.Methods The prospective study selected 58 patients with craniocerebral injury admitted to Department of Neurosurgery,Jieyang People's Hospital from September 2022 to August 2023 as the study objects.The patients were randomly divided into a control group and an observation group by the single blind method.The control group took mannitol and other sedative and analgesic drugs;in addition,the observation group took 3%hypertonic saline and dexmedetomidine.The serum levels of IL-6,TNF-α,NSE,and S100B were measured 12(T_(1)),24(T_(2)),48(T_(3)),and 72 h(T_(4))after injury.The data were compared between the two groups by t andχ^(2)tests.Results The serum levels of IL-6,TNF-α,NSE,and S100B at T_(2),T_(3),and T_(4)in the observation group were(276.11±18.64)ng/L,(165.07±15.32)ng/L,and(126.07±16.15)ng/L,(1.27±0.21)ng/L,(1.22±0.25)ng/L,and(0.78±0.15)ng/L,(16.74±3.51)μg/L,(19.07±4.91)μg/L,and(14.97±2.21)μg/L,and(0.47±0.15)μg/L,(0.56±0.23)μg/L,and(0.32±0.16)μg/L,and those in the control group were(315.23±19.54)ng/L,(199.05±16.16)ng/L,and(141.02±17.98)ng/L,(1.47±0.25)ng/L,(1.45±0.22)ng/L,and(0.91±0.19)ng/L,(20.17±3.21)μg/L,(24.17±5.61)μg/L,and(17.06±2.98)μg/L,and(0.67±0.28)μg/L,(0.87±0.32)μg/L,and(0.47±0.13)μg/L,the difference between the two groups was statistically significant(all P<0.05).Conclusion Three percent hypertonic saline combined with dexmedetomidine can inhibit the expression of neuroinflammatory factors in patients with severe craniocerebral injury and alleviate secondary brain injury.