右美托咪定对重症颅脑损伤患者围术期脑组织的保护作用及对血清炎性因子的影响
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摘要
目的:评价右美托咪定对重症颅脑损伤患者围术期脑组织的保护作用,并探讨其对血清炎性因子的影响。方法:选取2017年5月至2018年11月拟行颅脑手术的重症颅脑损伤患者120例,按随机数字表法分为对照组和观察组,每组60例。对照组患者给予丙泊酚+罗库溴铵+咪达唑仑+芬太尼常规麻醉诱导,观察组患者在对照组基础上加用右美托咪定。比较两组患者的镇静情况,手术前后脑氧代谢指标、血清炎性因子水平及预后良好率的差异。结果:观察组患者镇静所需时间、机械通气时间明显短于对照组,芬太尼用量明显少于对照组,差异均有统计学意义(P<0.05)。术后72 h,两组患者的颈内静脉血氧饱和度明显高于术前,颈内动静脉血氧含量差、脑组织氧摄取率明显低于术前,且观察组患者上述指标水平均明显优于对照组,差异均有统计学意义(P<0.05);两组患者的血清C反应蛋白、肿瘤坏死因子α、白细胞介素6及白细胞介素8水平均明显高于术前,但观察组患者上述指标水平均明显低于对照组,差异均有统计学意义(P<0.05)。观察组的预后良好率明显高于对照组,差异有统计学意义(P<0.05)。结论:右美托咪定用于重症颅脑损伤患者手术,可提高麻醉效率,减少麻醉药用量,降低脑耗氧量,改善脑代谢紊乱状态,降低炎性因子水平,抑制炎症反应,改善患者预后。
OBJECTIVE: To evaluate the protection effect of dexmedetomidine on perioperative brain tissue in patients with severe craniocerebral injury, and probe into its effect on serum inflammatory factors. METHODS: 120 patients with severe craniocerebral injury undergoing craniocerebral operations from May 2017 to Nov. 2018 were selected and divided into control group and observation group via random number table, with 60 cases in each group. The control group was given propofol + rocuronium + midazolam + fentanyl for routine anesthesia induction, while the observation group were given dexmedetomidine based on the control group. Differences in sedation, cerebral oxygen metabolism indices, serum inflammatory factor level and prognosis rate between two groups before and after surgery were compared. RESULTS: The time required for sedation and average mechanical ventilation time of observation group were significantly shorter than those of the control group. And the dose of fentanyl of observation group was significantly lower than that of control group, with statistically significant differnces(P<0.05). At 72 hours after operation, the jugular venous oxygen saturation of both groups were significantly higher than that of before operation, while the jugular arterial venous oxygen content difference and oxygen uptake rate of brain tissue were significantly lower than those of before operation, and those of the observation group were significantly better than the control group, with statistically significant differnces(P<0.05); the serum C-reactive protein, tumor necrosis factor α, interleukin-6 and interleukin-8 levels of both groups were significantly higher than those of before operation, and those of the observation group was significantly lower than the control group, with statistically significant differnces(P<0.05). The rate of favorable prognosis of observation group was significantly higher than that of the control group, with statistically significant differnces(P<0.05). CONCLUSIONS: The application of dexmedetomidine in the operation of severe craniocerebral injury can increase anesthesia efficiency, reduce the amount of anesthesia, lower brain oxygen consumption, improve brain metabolic disorder, decrease inflammatory factor levels, inhibit inflammatory response and promote patients' prognosis.
OBJECTIVE: To evaluate the protection effect of dexmedetomidine on perioperative brain tissue in patients with severe craniocerebral injury, and probe into its effect on serum inflammatory factors. METHODS: 120 patients with severe craniocerebral injury undergoing craniocerebral operations from May 2017 to Nov. 2018 were selected and divided into control group and observation group via random number table, with 60 cases in each group. The control group was given propofol + rocuronium + midazolam + fentanyl for routine anesthesia induction, while the observation group were given dexmedetomidine based on the control group. Differences in sedation, cerebral oxygen metabolism indices, serum inflammatory factor level and prognosis rate between two groups before and after surgery were compared. RESULTS: The time required for sedation and average mechanical ventilation time of observation group were significantly shorter than those of the control group. And the dose of fentanyl of observation group was significantly lower than that of control group, with statistically significant differnces(P<0.05). At 72 hours after operation, the jugular venous oxygen saturation of both groups were significantly higher than that of before operation, while the jugular arterial venous oxygen content difference and oxygen uptake rate of brain tissue were significantly lower than those of before operation, and those of the observation group were significantly better than the control group, with statistically significant differnces(P<0.05); the serum C-reactive protein, tumor necrosis factor α, interleukin-6 and interleukin-8 levels of both groups were significantly higher than those of before operation, and those of the observation group was significantly lower than the control group, with statistically significant differnces(P<0.05). The rate of favorable prognosis of observation group was significantly higher than that of the control group, with statistically significant differnces(P<0.05). CONCLUSIONS: The application of dexmedetomidine in the operation of severe craniocerebral injury can increase anesthesia efficiency, reduce the amount of anesthesia, lower brain oxygen consumption, improve brain metabolic disorder, decrease inflammatory factor levels, inhibit inflammatory response and promote patients' prognosis.
引文
[1] 陆斌,陈思.脑苷肌肽注射液联合鼠神经生长因子注射剂治疗重症颅脑损伤的临床研究[J].中国临床药理学杂志,2017,33(15):1397-1399.
[2] 陈晓梅,陈广福.右美托咪定对颅内肿瘤手术患者血流动力学的影响及脑保护作用[J].临床麻醉学杂志,2015,31(1):15-17.
[3] 沈建忠.老年脑外伤患者围术期格拉斯哥昏迷评分和血液流变学变化对术后继发大面积脑梗死的评估价值[J].中国老年学杂志,2014,35(6):1550-1551.
[4] 贾献辉,叶常红.罗哌卡因与地佐辛联合使用对颅脑外科ASA Ⅰ、Ⅱ级患者全麻恢复期躁动的影响[J].中国生化药物杂志,2016,36(1):89-91.
[5] 郝彬,赵红果,周璐,等.神经外科颅脑术后伴手术部位感染患者神经功能及脑氧代谢指标的变化[J].中华医院感染学杂志,2016,26(17):3990-3992.
[6] 沈健,杨华.不同手术时机小骨窗显微手术治疗高血压脑出血与日常生活活动能力量表、格拉斯哥预后评分的相关性[J].中国老年学杂志,2017,37(2):354-356.
[7] 李水莉,李颖,赵丽丽,等.降阶梯思维方式在颅脑损伤合并颈椎损伤患者急救护理中应用的效果评价[J].中国实用护理杂志,2015,31(7):498-500.
[8] Ozaki M,Takeda J,Tanaka K,et al.Safety and efficacy of dexme-detomidine for long-term sedation in critically ill patients[J].J Anesth,2014,28(1):38-50.
[9] 王云,胡学芹.早期气管切开对颅脑外伤合并出血患者脑氧代谢及神经功能的影响研究[J].河北医学,2016,22(4):558-560.
[10] 刘静.右美托咪定对颈动脉内膜剥脱术患者脑氧代谢、神经功能以及炎症反应的调节作用[J].海南医学院学报,2016,22(11):1097-1100.
[11] 宋增亮,李世清,曹利华,等.重型颅脑损伤标准大骨瓣开颅术患者围术期炎性应激及代谢状态的变化[J].中国实用神经疾病杂志,2016,19(17):28-30.
[12] 王佳,张红玉.不同程度颅脑损伤后炎症因子的表达及其临床意义[J].中国现代医学杂志,2016,26(3):72-75.
[13] 陈骏.神经节苷脂治疗重型颅脑损伤患者效果及对血清炎症指标和神经元特异性烯醇化酶水平的影响[J].中国老年学杂志,2016,36(17):4299-4300.
[14] 张韫辉,高金贵,张山,等.右美托咪定对颅脑损伤患者全麻下开颅术时的脑保护作用[J].中华麻醉学杂志,2015,35(1):30-32.
[15] 杨超,白奎,张二辉,等.右美托咪定对严重颅脑损伤患者围手术期炎性因子及脑氧代谢的影响[J].中国实用神经疾病杂志,2017,20(7):65-67.
[2] 陈晓梅,陈广福.右美托咪定对颅内肿瘤手术患者血流动力学的影响及脑保护作用[J].临床麻醉学杂志,2015,31(1):15-17.
[3] 沈建忠.老年脑外伤患者围术期格拉斯哥昏迷评分和血液流变学变化对术后继发大面积脑梗死的评估价值[J].中国老年学杂志,2014,35(6):1550-1551.
[4] 贾献辉,叶常红.罗哌卡因与地佐辛联合使用对颅脑外科ASA Ⅰ、Ⅱ级患者全麻恢复期躁动的影响[J].中国生化药物杂志,2016,36(1):89-91.
[5] 郝彬,赵红果,周璐,等.神经外科颅脑术后伴手术部位感染患者神经功能及脑氧代谢指标的变化[J].中华医院感染学杂志,2016,26(17):3990-3992.
[6] 沈健,杨华.不同手术时机小骨窗显微手术治疗高血压脑出血与日常生活活动能力量表、格拉斯哥预后评分的相关性[J].中国老年学杂志,2017,37(2):354-356.
[7] 李水莉,李颖,赵丽丽,等.降阶梯思维方式在颅脑损伤合并颈椎损伤患者急救护理中应用的效果评价[J].中国实用护理杂志,2015,31(7):498-500.
[8] Ozaki M,Takeda J,Tanaka K,et al.Safety and efficacy of dexme-detomidine for long-term sedation in critically ill patients[J].J Anesth,2014,28(1):38-50.
[9] 王云,胡学芹.早期气管切开对颅脑外伤合并出血患者脑氧代谢及神经功能的影响研究[J].河北医学,2016,22(4):558-560.
[10] 刘静.右美托咪定对颈动脉内膜剥脱术患者脑氧代谢、神经功能以及炎症反应的调节作用[J].海南医学院学报,2016,22(11):1097-1100.
[11] 宋增亮,李世清,曹利华,等.重型颅脑损伤标准大骨瓣开颅术患者围术期炎性应激及代谢状态的变化[J].中国实用神经疾病杂志,2016,19(17):28-30.
[12] 王佳,张红玉.不同程度颅脑损伤后炎症因子的表达及其临床意义[J].中国现代医学杂志,2016,26(3):72-75.
[13] 陈骏.神经节苷脂治疗重型颅脑损伤患者效果及对血清炎症指标和神经元特异性烯醇化酶水平的影响[J].中国老年学杂志,2016,36(17):4299-4300.
[14] 张韫辉,高金贵,张山,等.右美托咪定对颅脑损伤患者全麻下开颅术时的脑保护作用[J].中华麻醉学杂志,2015,35(1):30-32.
[15] 杨超,白奎,张二辉,等.右美托咪定对严重颅脑损伤患者围手术期炎性因子及脑氧代谢的影响[J].中国实用神经疾病杂志,2017,20(7):65-67.