标题：右美托咪定对颅内肿瘤切除患者血流动力学的影响及脑保护效应研究

      作者：武辉 1，薛荣亮 2，李雪丹 3，陈皎 3    1.西安交通大学，陕西 西安 710048；2.西安交通大学第二附属医院麻醉科，陕西 西安 710004；3.汉中市中心医院麻醉科，陕西 汉中 723000

      卷次： 2022年33卷7期

      【摘要】 目的 研究右美托咪定对颅内肿瘤切除患者血流动力学的影响及其脑保护效应。方法 前瞻性选取2018年6月至2020年6月间西安交通大学第二附属医院收治的择期行颅内肿瘤切除术的86例患者作为研究对象，采用随机数表法将患者分为右美托咪定组和对照组，每组34例。右美托咪定组和对照组患者分别在麻醉诱导前给予右美托咪定及等量生理盐水，于麻醉诱导前(T0)、切皮即刻(T1)、取瘤完毕(T2)、术毕(T3)、术后2 h (T4)记录患者平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)指标；记录患者苏醒时间、拔除气管导管时间；于T0、T3、T4、术后24 h (T5)、术后3 d (T6)时测定并比较两组患者的血清S-100β蛋白、神经元特异性烯醇化酶(NSE)、神经胶质纤维酸性蛋白(GFAP)、肿瘤坏死因子α (TNF-α)及白细胞介素-6 (IL-6)水平。结果 右美托咪定组患者T2~T4时间点的MAP、HR明显低于对照组，差异均有统计学意义(P<0.05)；右美托咪定组患者术后苏醒时间、拔除气管导管时间短于对照组，差异均有统计学意义(P<0.05)；T4~T5时间点右美托咪定组血清S-100β、NSE、GFAP明显低于对照组，差异均有统计学意义(P<0.05)；T3~T5时间点右美托咪定组血清TNF-α、IL-6水平明显低于对照组，差异均有统计学意义(P<0.05)。结论 右美托咪定可降低脑肿瘤手术患者血流动力学波动，促进术后认知功能恢复，抑制炎症因子释放可能为脑损伤保护机制之一。
      【关键词】 右美托咪定；颅内肿瘤；麻醉诱导；血流动力学；脑损伤；炎症因子
      【中图分类号】 R739.41 【文献标识码】 A 【文章编号】 1003—6350（2022）07—0849—05

Influence of dexmedetomidine on hemodynamics in patients undergoing intracranial tumor resection and its brainprotection effect.
WU Hui 1, XUE Rong-liang 2, LI Xue-dan 3, CHEN Jiao 3. 1. Xi'an Jiaotong University, Xi'an 710048,Shaanxi, CHINA; 2. Department of Anesthesiology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004,Shaanxi, CHINA; 3. Department of Anesthesiology, Hanzhong Central Hospital, Hanzhong 723000, Shaanxi, CHINA
【Abstract】 Objective To study the influence of dexmedetomidine on hemodynamics in patients undergoing in-tracranial tumor resection, and its brain protection effect. Methods This prospective study included 86 patients who un-derwent elective intracranial tumor resection in the Second Affiliated Hospital of Xi'an Jiaotong University between June2018 and June 2020. Patients enrolled were divided into dexmedetomidine group and control group by random numbertable method, with 34 cases in each group. The two groups were respectively treated with dexmedetomidine and thesame amount of normal saline before anesthesia induction. Mean arterial pressure (MAP), heart rate (HR) and blood oxy-gen saturation (SpO2) before anesthesia induction (T0), at skin incision (T1), after tumor removal (T2), at the end of sur-gery (T3), and at 2 h after surgery (T4) were recorded. The recovery time and time of tracheal tube removal were record-ed. The levels of serum S-100β protein, neural specific enolase (NSE), glial fibrillary acidic protein (GFAP), tumor ne-crosis factor α (TNF-α) and interleukin-6 (IL-6) of the two groups at T0, T3, T4, 24 h after surgery (T5) and 3 d aftersurgery (T6) were measured and compared. Results From T2 to T4, MAP and HR of the dexmedetomidine group weresignificantly lower than those of the control group, with statistically significant differences (P<0.05). The recovery timeand time of tracheal tube removal were shorter than those of the control group, with statistically significant differences(P<0.05). Compared with T0, the levels of serum S-100β, NSE, GFAP, TNF-α and IL-6 in both groups increased firstand then decreased from T3 to T6, with statistically significant differences (P<0.05). From T4 to T5, the levels of se-rum S-100β, NSE and GFAP in the dexmedetomidine group were significantly lower than those in the control group,with statistically significant differences (P<0.05). From T3 to T5, the levels of serum TNF-α and IL-6 in the dexme-detomidine group were significantly lower than those in the control group, with statistically significant differences (P<0.05). Conclusion Dexmedetomidine can reduce hemodynamic fluctuations in patients undergoing brain tumor sur-gery, promote postoperative cognitive function recovery, and inhibit release of inflammatory factors, which may be themechanism of brain injury protection.
      【Key words】 Dexmedetomidine; Intracranial tumor; Anesthesia induction; Hemodynamics; Brain injury; Inflam-matory factor