| 庞小翼,张培根,赵 径,周 阳,王 忠,刘 斌.右美托咪定在颅脑外伤手术患者中的脑保护作用及其对应激反应和炎症因子的影响[J].,2018,(19):3759-3763 |
| 右美托咪定在颅脑外伤手术患者中的脑保护作用及其对应激反应和炎症因子的影响 |
| Effect of Dexmedetomidine on Brain Protection and Its Effect on Stress Response and Inflammatory Factors of Patients in the Operation of Craniocerebral Trauma |
| 投稿时间：2018-04-16 修订日期：2018-05-10 |
| DOI：10.13241/j.cnki.pmb.2018.19.036 |
| 中文关键词: 右美托咪定 咪唑安定 颅脑外伤 脑保护 应激反应 炎症因子 |
| 英文关键词: Dexmedetomidine Midazolam Craniocerebral trauma Brain protection Stress response Inflammatory factors |
| 基金项目:四川省卫生厅科研基金项目（125231） |
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| 中文摘要: |
| 摘要 目的：探讨右美托咪定在颅脑外伤手术患者中的脑保护作用及其对应激反应和炎症因子的影响。方法：选取四川绵阳四〇四医院于2016年1月-2017年12月期间收治的重型颅脑外伤患者136例为研究对象。根据随机数字表法将患者分为对照组（n=68）与研究组（n=68），其中对照组手术时给予咪唑安定静脉滴注，研究组手术时给予右美托咪定静脉滴注，比较两组患者术前（T1）、术后24 h（T7）血浆S-100β蛋白、神经元特异性烯醇化酶（NSE）、脑氧摄取率（CERO2）、动脉-颈内静脉血氧含量差（Da-jvO2）、颈静脉血氧饱和度（Sjv O2）水平，桡动脉成功穿刺时（T2）、气管插管时（T3）、上开口器时（T4）、手术结束时（T5）、拔管时（T6）皮质醇（COR）、肾上腺素（E）、血糖（GLU）水平，T2、T5、T7白细胞介素-6（IL-6）、白细胞介素-10（IL-10）、肿瘤坏死因子-α（TNF-α）水平。结果：两组患者T7时S-100β蛋白、NSE较T1时显著升高，但研究组低于对照组（P<0.05）。两组患者T7时 CERO2、Da-jvO2较T1时降低，且研究组低于对照组，SjvO2较T1时升高，且研究组高于对照组（P<0.05）。在T4-T6时间点时，研究组GLU显著低于对照组，在T3-T6时间点时，研究组COR、E显著低于对照组（P<0.05）。两组患者T5、T7时IL-6、IL-10、TNF-α均较T2时升高，且研究组T5、T7时IL-6、TNF-α低于对照组，IL-10高于对照组（P<0.05）。结论：相对咪唑安定而言，在颅脑外伤手术中使用右美托咪定可显著减少脑损伤，降低炎症因子水平，且患者应激反应较小。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effect of dexmedetomidine on brain protection and its effect on stress response and in- flammatory factors of patients in the operation of craniocerebral trauma. Methods: 136 patients with severe craniocerebral trauma who were treated in our hospital from January 2016 to December 2017 were selected as the research subjects, and the patients were divided into the control group (n=68) and the study group (n=68) according to the random digital table. The control group was given midazolam by in- travenous drip during the operation, the study group was given dexmedetomidine by intravenous drip during the operation. The plasma S-100β protein, neuron specific enolase (NSE), cerebral extraction of oxygen (CERO2), arterio-jugular difference of oxygen (Da-jvO2) and jugular venous oxygen saturation (SjvO2) levels of two groups before operation (T1), postoperative 24 h (T7) were compared, cortisol (COR), adrenaline (E) and blood glucose (GLU) levels at successful puncture of radial artery(T2), endotracheal intubation (T3), upper opening device (T4), end of operation (T5), extubation (T6) were compared, and the levels of interleukin-6 (IL-6), interleukin-10 (IL-10) and tumor necrosis factor-α(TNF-α) at T2, T5, T7 were compared. Results: S-100β protein and NSE of patients in the two groups at T7 were significantly higher than those of T1, but the study group was lower than the control group (P<0.05). CERO2 and Da-jvO2 of pa- tients in the two groups at T7 was lower than that of T1, and the study group was lower than the control group, SjvO2 was higher than that of T1, and the study group was higher than that of the control group (P<0.05). At the time point of T4-T6, GLU of the study group was significantly lower than the control group, at the time point of T3-T6, the COR and E of the study group were significantly lower than the control group (P<0.05). The levels of IL-6, IL-10 and TNF-α in the two groups at T5 and T7 were higher than those of T2, the IL-6 and TNF-α in the study group at T5 and T7 were lower than those in the control group, and the IL-10 was higher than that of the control group (P<0.05). Conclusion: Compared with midazolam, dexmedetomidine can significantly reduce brain injury and reduce inflammatory factors in patients with craniocerebral trauma, and the stress response is relatively small. |
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