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目的探讨右美托咪定对颅脑肿瘤患者围手术期的脑保护作用。方法选取2013年7月至2015年7月新疆医科大学附属肿瘤医院收治的68例行择期手术的颅脑肿瘤患者为研究对象,依据随机数字表法将患者分为对照组和右美托咪定组,每组34例。右美托咪定组患者常规全身麻醉诱导前10 min静脉输注1μg/kg的右美托咪定,以0.5μg/(kg·h)速率维持至术毕;对照组输注等量的0.9%氯化钠注射液。分别于麻醉诱导前(T_0)、打开硬脑膜时(T_1)、术中(T_2)、术毕(T_3)及手术结束后1 h(T_4)对两组患者白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、特异性烯醇化酶(NSE)水平以及平均动脉压、颅内压和心率进行分析;比较两组患者舒芬太尼用量、呼气末七氟醚浓度、拔管时间、麻醉苏醒时间。结果两组患者IL-6、TNF-α、NSE水平以及颅内压、平均动脉压和心率在组间、时点间以及组间·时点间交互作用比较,差异均有统计学意义(P<0.01)。两组患者IL-6、TNF-α、NSE水平先升高后降低,直至接近麻醉诱导前,其中右美托咪定组较对照组更接近;右美托咪定组患者的颅内压、平均动脉压的波动较小,而对照组的波动较大;右美托咪定组患者的心率受到抑制,次数降低,而对照组整个手术过程中均在正常范围内。右美托咪定组芬太尼用量、呼气末七氟醚浓度少于对照组,拔管时间、麻醉苏醒时间短于对照组[(412.8±39.6)μg比(648.2±69.3)μg、(1.2±0.4)%比(2.9±0.6)%、(64.6±8.4)min比(84.4±9.6)min、(32.9±3.8)min比(69.3±5.9)min,P<0.01]。结论右美托咪定能有效减轻颅脑肿瘤手术患者围术期的炎症反应,维持患者血流动力学稳定,同时减少吸入麻醉药物及阿片类药物用量,缩短患者麻醉苏醒时间。
Objective To investigate the protective effect of dexmedetomidine on perioperative brain injury in patients with brain tumor. Methods From July 2013 to July 2015, 68 patients with craniocerebral tumor who underwent selective elective surgery admitted to Tumor Hospital of Xinjiang Medical University were divided into control group and dexmedetomidine Group, 34 cases in each group. The patients in the dexmedetomidine group received intravenous infusion of 1 μg / kg of dexmedetomidine 10 min prior to general anesthesia induction at a rate of 0.5 μg / (kg · h). The control group received 0.9 % Sodium chloride injection. The levels of interleukin 6 (IL-6), interleukin-6 (IL-6) and interleukin-6 (IL-6) in the two groups were measured before induction of anesthesia (T 0), dilatation of the dura (T 1), intraoperative (T 2), postoperative T 3 and 1 h , Tumor necrosis factor α (TNF-α), specific enolase (NSE) levels and mean arterial pressure, intracranial pressure and heart rate were analyzed. The sufentanil dosage, end-tidal sevoflurane concentration , Extubation time, anesthesia recovery time. Results The levels of IL-6, TNF-α, NSE and the intracranial pressure, mean arterial pressure and heart rate in the two groups were significantly different among groups and at different time points and between groups (P <0.01). The levels of IL-6, TNF-αand NSE in both groups firstly increased and then decreased until they were close to the induction of anesthesia, and the dexmedetomidine group was more similar than the control group. The patients with dexmedetomidine group had higher intracranial pressure, The fluctuation of mean arterial pressure was small, while the fluctuation of the control group was larger. The heart rate of the patients in the dexmedetomidine group was suppressed and the number of times was decreased, while the control group was in the normal range during the whole operation. The dose of fentanyl and end-expiratory sevoflurane in the dexmedetomidine group were less than those in the control group. The extubation time and anesthesia recovery time were shorter than those in the control group [(412.8 ± 39.6) μg vs (648.2 ± 69.3) μg, 1.2 ± 0.4% vs 2.9 ± 0.6% vs 64.6 ± 8.4 min vs 84.4 ± 9.6 min vs 32.9 ± 3.8 min vs 69.3 ± 5.9 min, P <0.01). Conclusion Dexmedetomidine can effectively reduce perioperative inflammatory response in patients with craniocerebral tumors, maintain hemodynamic stability, reduce the amount of inhaled anesthetics and opioids, and shorten the anesthesia recovery time.