CAJ | 학술논문

目的探讨盐酸右美托咪定(dexmedetomidine,Dex)对脑膜瘤患者胶质纤维酸性蛋白(glial fibrillary acidic protein,GFAP)及肌酸激酶脑型同工酶(brain typeisoenzyme of creatine phosphokinase,CK-BB)表达的影响,评估Dex对脑膜瘤患者术中脑保护的作用. 方法选择择期行脑膜瘤切除术患者45例,年龄45岁～65岁,体重在55 kg～65 kg,美国麻醉医师协会(ASA)分级Ⅱ或Ⅲ级,采用随机数字表法将患者分为3组(每组15例):对照组(C组),Dex低剂量组(D1组),Dex高剂量组(D2组),D1组和D2组于常规诱导前10 min静脉输注Dex负荷量1μg/kg,继之分别以0.2 μg· kg-1·h-1和0.5 μg· kg-1·h-1持续输注至术毕前30 min,C组给与等容量的生理盐水.3组术中维持脑电双频指数(bispectral index,BIS)值在40～49之间,分别于麻醉诱导前(T1)、取出肿瘤时(T2)、拔管时(T3)、术后24 h(T4)采集静脉血样,测定血清中GFAP及CK-BB的浓度,且分别于T1、T2、T3时采集桡动脉及颈静脉球部的血样行血气分析,记录并计算动脉血氧含量(arterial oxygen content,CaO2)、脑动脉-静脉血氧含量差(cerebral arterial venous oxygen content difference,Da-jvO2)和脑氧摄取(cerebral extraction of oxygen,CEO2). 结果与T1时比较,3组T2～T4时血清GFAP、CK-BB浓度及CEO2升高(P＜0.05);T2～T4时D2组血清GFAP[(0.72±0.05)、(0.80±0.05)、(0.90±0.05) μg/L]及CK-BB[(19.3±1.8) 、(21.1±2.4)、(23.5±2.8) U/L]浓度与C组血清GFAP[(0.78±0.06)、(0.88±0.07)、(1.17±0.19) μg/L]及CK-BB[(30.6±2.6)、(33.2±3.4)、(36.1±2.8) U/L]浓度比较差异有统计学意义(P＜0.05);T2、T3时D1组CEO2[(0.33±0.04)％,(0.30±0.04)％]和D2组CEO2[(0.32±0.04)％,(0.26±0.04)％]与C组CEO2[(0.36±0.03)％,(0.34±0.03)％]比较,差异有统计学意义(P＜0.05),但D2组降低更为显著(P＜0.01). 结论静脉输注Dex可对围术期脑膜瘤患者发挥脑保护作用,其机制可能与降低血液GFAP、CK-BB的浓度及CEO2有关.
목적 탐토염산우미탁미정(dexmedetomidine,Dex)대뇌막류환자효질섬유산성단백(glial fibrillary acidic protein,GFAP)급기산격매뇌형동공매(brain typeisoenzyme of creatine phosphokinase,CK-BB)표체적영향,평고Dex대뇌막류환자술중뇌보호적작용. 방법 선택택기행뇌막류절제술환자45례,년령45세～65세,체중재55 kg～65 kg,미국마취의사협회(ASA)분급Ⅱ혹Ⅲ급,채용수궤수자표법장환자분위3조(매조15례):대조조(C조),Dex저제량조(D1조),Dex고제량조(D2조),D1조화D2조우상규유도전10 min정맥수주Dex부하량1μg/kg,계지분별이0.2 μg· kg-1·h-1화0.5 μg· kg-1·h-1지속수주지술필전30 min,C조급여등용량적생리염수.3조술중유지뇌전쌍빈지수(bispectral index,BIS)치재40～49지간,분별우마취유도전(T1)、취출종류시(T2)、발관시(T3)、술후24 h(T4)채집정맥혈양,측정혈청중GFAP급CK-BB적농도,차분별우T1、T2、T3시채집뇨동맥급경정맥구부적혈양행혈기분석,기록병계산동맥혈양함량(arterial oxygen content,CaO2)、뇌동맥-정맥혈양함량차(cerebral arterial venous oxygen content difference,Da-jvO2)화뇌양섭취(cerebral extraction of oxygen,CEO2). 결과 여T1시비교,3조T2～T4시혈청GFAP、CK-BB농도급CEO2승고(P＜0.05);T2～T4시D2조혈청GFAP[(0.72±0.05)、(0.80±0.05)、(0.90±0.05) μg/L]급CK-BB[(19.3±1.8) 、(21.1±2.4)、(23.5±2.8) U/L]농도여C조혈청GFAP[(0.78±0.06)、(0.88±0.07)、(1.17±0.19) μg/L]급CK-BB[(30.6±2.6)、(33.2±3.4)、(36.1±2.8) U/L]농도비교차이유통계학의의(P＜0.05);T2、T3시D1조CEO2[(0.33±0.04)％,(0.30±0.04)％]화D2조CEO2[(0.32±0.04)％,(0.26±0.04)％]여C조CEO2[(0.36±0.03)％,(0.34±0.03)％]비교,차이유통계학의의(P＜0.05),단D2조강저경위현저(P＜0.01). 결론 정맥수주Dex가대위술기뇌막류환자발휘뇌보호작용,기궤제가능여강저혈액GFAP、CK-BB적농도급CEO2유관.
Objective To evaluate the effect of dexmedetomidine (Dex) on glial fibrillary acidic protein (GFAP) and brain typeisoenzyme of creatine phosphokinase (CK-BB) concentration during perioperative period in patients with meningioma,and to evaluate the cerebral protection function of Dex during surgery.Methods Forty-five ASA Ⅱ or Ⅲ patients with meningioma aged 45 y-65 y weighing 55 kg-65 kg scheduled for elective intracranial tumor recection were randomly divided into 3 groups (n=15):control group (group C),low-dose Dex group (0.2 μg·kg-1·h-1,group D1),high dose Dex group 0.5 μg·kg-1·h-1(group D2).Dex was intravenously infused 10 min before induction at the dose of 1 μg/kg,followed by constant speed infusion at 0.2 μg·kg1·h-1 and 0.5μg·kg-1·h-1 in grgup D1 and D2 respectively until 30 min before the end of the operation.Group C received the same volume of saline.Bispectral index (BIS) was maintained at 40-49.Venous blood samples were taken for determination of serum concentrations of GFAP and CK-BB respectively before induction (T1),at the time of dislodging tumor (T2),during extubating trachea (T3) and 24 h after operation(T4).Blood samples were also collected from left radial artery and right jugular venous bulb for blood gas analysis to calculate the arterial oxygen content(CaO2),cerebral arterial venous oxygen content difference(Da-jvO2),cerebral extraction of oxygen(CEO2).Results Compared with T1,the concentration of GFAP and CK-BB in serum and CEO2 significantly increased at T2-T4 in all of the groups (P＜0.05).There was significant difference between group C and group D2 in the concentration of GFAP and CK-BB in serum at T2-T4(P＜0.05),The numerical values of GFAP in serum in group C were[(0.72±0.05),(0.80-±0.05),(0.90±0.05) μg/L],while that of group D2 were [(0.78±0.06),(0.88±0.07),(1.17±0.19) μg/L],respectively at T2-T4.The numerical values of CK-BB in serum in group C were [(30.6±2.6),(33.2±3.4),(36.1±2.8) U/L],while that of group D2 were [(19.3±1.8),(21.1±2.4),(23.5±2.8) U/L],respectively at T2-T4.There was significant diferenee in the three groups about CEO2 at T2-T3(P＜0.05),The numerical values of CEO2 in group C were [(0.36±0.03)％,(0.34±0.03)％],while that of group D1 were [(0.33±0.04)％,(0.30±0.04)％],and group D2 were [(0.32±0.04)％,(0.26 ±0.04)％],respectively at T2-T3.Conclusions Intraoperative infusion of dexmedetomidine may play a protective effect on (role in) patients with meningioma,The mechanism may be associated with lowering plasma GFAP and CK-BB concentrations and cerebral oxygen uptake rate.