右美托咪定对开颅动脉瘤夹闭术患者的脑保护作用

Neuroprotective Effect of Dexmedetomidine on Patients Undergoing Craniotomy and Clipping of Intracranial Aneurysm

关键词:  颅内动脉瘤  手术夹闭  右美托咪定  脑保护

Key words:  intracranial aneurysm  surgical clipping  dexmedetomidine  neuroprotection

摘要:

目的 观察右美托咪定(dexmedetomidine，DEX)对开颅动脉瘤夹闭术患者围术期炎症因子及神经损伤标记物表达的影响，研究其脑保护作用。方法 择期开颅动脉瘤夹闭术患者60例，随机数表法将其均分为对照组和右美托咪啶组。右美托咪啶组患者麻醉诱导前给予DEX 1 μg·kg^-1，然后以0.5 μg·kg^-1·h^-1速度持续输注至手术结束；对照组患者在同时段给予等量生理盐水。分别于麻醉后切皮前(T0)、载瘤动脉阻断开始时(T₁)、载瘤动脉阻断结束时(T₂)、手术结束时(T₃)、手术结束后24 h(T₄)及手术结束后72 h(T₅)6个时间点从颈静脉球部采集血液标本，采用ELISA法检测肿瘤坏死因子-α(tumor necrosis factor-α，TNF-α)、白介素-6(interleukin-6，IL-6)、白介素-10(interleukin-10，IL-10)、星形胶质细胞S100蛋白的β亚型(beta isoform of S100 protein in astrocytes，S-100β蛋白)及神经元特异性烯醇化酶(neuronspecific enolase，NSE)。结果 T₁~T₃ 2组TNF-α、IL-6、IL-10、S-100β及NSE均高于组内T₀(P<0.05)，右美托咪啶组TNF-α、IL-6、S-100β及NSE均低于同时点对照组(P<0.05)，右美托咪啶组IL-10均高于同时点对照组(P<0.05)；T₄时间点，除右美托咪啶组TNF-a、S-100β及NSE外，2组各指标均高于组内T₀(P<0.05)，右美托咪啶组IL-6及NSE低于同时点对照组(P<0.05)，右美托咪啶组IL-10高于同时点对照组(P<0.05)；T₅时间点，对照组IL-6及右美托咪啶组IL-6和IL-10高于组内T₀(P<0.05)。结论 DEX可以在一定程度上抑制开颅动脉瘤夹闭术患者围术期促炎因子和神经损伤标记物表达，同时促进抗炎因子表达，具有脑保护作用。

Abstract:

OBJECTIVE To evaluate the neuroprotective effect of dexmedetomidine(DEX) on patients undergoing craniotomy and clipping of intracranial aneurysm. METHODS Sixty patients undergoing craniotomy and intracranial aneurysm clipping were randomized into 2 groups each containing 30 subjects. In dexmedetomidine group, before induction of anesthesia DEX was administered with a loading dose of 1 μg·kg^-1 followed by maintenance dose of 0.5 μg·kg^-1·h^-1, while the same dose of normal saline was administered in control group. Before anesthesia induction(T₀), beginning of blocking the artery of intracranial aneurysm(T₁), end of blocking the artery of intracranial aneurysm surgery(T₂)，end of surgery(T₃), 24 h after end of surgery(T₄) and 72 h after end of surgery(T₅), venous blood samples from jugular bulb catheters were drawn, serum content of tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), interleukin-10(IL-10), beta isoform of S100 protein in astrocytes(S-100β protein) and neuron-specific enolase(NSE) were determined by ELISA. RESULTS From T₁ to T₃, the serum concentrations of TNF-α, IL-6, IL-10, S-100β and NSE in 2 groups were significantly higher than those at T₀(P<0.05); the serum content of TNF-α, IL-6, S-100β and NSE were significantly lower in dexmedetomidine group than that in control group(P<0.05); the serum concentrations of IL-10 was significantly higher in dexmedetomidine group than that in control group(P<0.05). CONCLUSION DEX can reduce the expression of proinflammatory factors and nerve injury markers, and increase the expression of anti-inflammatory molecules. It has neuroprotective effect on patients undergoing craniotomy and clipping of intracranial aneurysm.