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目的 评价右美托咪定对脑血管病手术患者的脑保护作用.方法 择期脑血管病手术患者64例,年龄19～67岁,体表面积1.7～2.1 m2,ASA分级Ⅰ级或Ⅱ级.采用随机数字表法,将患者均分为右美托咪定组(D组,n=32)和对照组(C组,n=32).麻醉诱导前D组经静脉10 min内输注右美托咪定1μg· kg-1,随后以0.7μg· kg-1·h-1输注至术毕;C组给予等量生理盐水.观察2组患者麻醉诱导前(T0)、夹闭或切除病灶前即刻(T1)、夹闭或切除病灶后5 min(T2)、手术结束时(T3)及手术结束后24 h(T4)血液中星形胶质细胞S100蛋白的β亚型(S-100β)和神经元特异性烯醇化酶(NSE)浓度;采用简易智力状态检查量表(MMSE)评估2组患者术前1d、术后1周及术后6个月的认知功能水平.结果 C组S-100β及NSE浓度在T2-4时刻较在T0时刻升高(P＜0.05),D组虽有升高但差异未见统计学意义(P＞0.05);D组S-100β浓度在T2-4时低于C组(P＜0.05);D组术后1周MMSE评分高于C组(P＜0.05).结论 麻醉诱导前静脉输注右美托咪定1μg· kg-1随后以0.7μg· kg-1·h-1剂量输注至术毕,对脑血管病手术患者可能有一定的脑保护作用.“,”AIM To evaluate the cerebral protective effect of dexmedetomidine in patients undergoing surgery with cerebral vascular disease.METHODS Totally 64 patients undergoing operation for cerebrovascular disease,aged 19-67 years old,with body surface area of 1.7-2.1 m2,of ASA Ⅰ or Ⅱ,were equally randomized into 2 groups:the experimental group (group D) was loaded dexmedetomindine doses of 1 μg · kg-1 and maintained with 0.7 μg · kg-1 · h-1,and the control group(group C) was maintained with equal volume of saline.At 15 min before induction(T0),at clipping or focal excision (T1),at 5 min after clipping or focal excision(T2),at the end of surgery(T3) and at 24 h after surgery(T4),the dynamic concentration levels change of human serum S-100 protein (S-100β) and neurone specific enolase(NSE) were compared;cognitive function were evaluated with MMSE at 1d before surgery,1week after surgery and 6 months after surgery.RESULTS In group C,the levels of S-100β and NSE in T2-4 were significantly higher than those at T0(P ＜0.05),but no difference was found in group D(P ＞0.05);in T2-4,the level of S-100β in group D was significantly lower than that in group C (P ＜ 0.05);1week MMSE score after operation in group D was significantly higher than that in group C (P ＜ 0.05).CONCLUSION Dexmedetomindine(loaded doses of 1μg · kg-1 and followed by 0.7 μg · kg-1 · h-1 until the end of surgery) has a cerebral protective effect in patients undergoing operation for cerebrovascular disease.