国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2013年
5期
403-407
,共5页
李爱梅%石翊飒%李雅楠%韩杰%高瑞萍%张喜洋
李愛梅%石翊颯%李雅楠%韓傑%高瑞萍%張喜洋
리애매%석익삽%리아남%한걸%고서평%장희양
盐酸右美托咪啶%神经保护%脑膜瘤%脑氧摄取率
鹽痠右美託咪啶%神經保護%腦膜瘤%腦氧攝取率
염산우미탁미정%신경보호%뇌막류%뇌양섭취솔
Dexmedetomidine%Neuroprotection%Meningioma%Cerebral extraction of O2
目的 评价盐酸右美托咪啶(dexmedetomidine,DEX)对脑膜瘤患者围术期的脑保护效应.方法 本研究采用前瞻性随机双盲对照设计,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～Ⅲ级,采用随机数字表法,将患者随机分为3组(每组15例):生理盐水对照组(C组),DEX低剂量组(D1),DEX高剂量组(D2),D1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组给予等容量的生理盐水.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S100β及神经元特异性烯醇化酶(neuron-specific enolase,NSE)的浓度,且分别于T1、T2、T3采集桡动脉及颈静脉球部的血样行血气分析,记录并计算脑氧摄取率(cerebral extraction of O2,CEO2).观察患者围术期血压、心率变化. 结果 与T1时比较,3组T2～T4时血清S100β、NSE浓度及CEO2升高(P＜0.05);T2～T4时C组血清NSE[(20.1±1.7)、(26.5±2.9)、(36.1±2.5) μg/L]与D2组血清NSE [(13.9±2.3)、(16.4±2.4)、(20.0±2.9) μg/L]比较差异有统计学意义(P＜0.05),T2±T4时C组血清S100β浓度[(0.73±0.08)、(0.86-±-0.08)、(1.17±0.20)μg/L]与D2组血清S100β浓度[(0.65±0.05)、(0.73±0.06)、(0.896±0.051) μg/L]比较差异有统计学意义(P＜0.05),C组与D1组血清NSE、S100β变化比较差异无统计学意义.T2～T3时C组CEO2[(0.36±0.03)、(0.34±0.03)],与D1组[(0.33±0.04)、(0.30±0.04)]比较差异有统计学意义(P＜0.05),与D2组[(0.32±0.04)、(0.26±0.04)]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 围术期持续输注DEX可降低脑膜瘤患者CEO2,稳定围术期血流动力学,产生脑保护效应,其机制可能与降低血S100β、NSE水平有关.
目的 評價鹽痠右美託咪啶(dexmedetomidine,DEX)對腦膜瘤患者圍術期的腦保護效應.方法 本研究採用前瞻性隨機雙盲對照設計,選擇擇期行腦膜瘤切除術患者45例,年齡45歲～65歲,體重在55 kg～65 kg,美國痳醉醫師協會(ASA)分級Ⅱ～Ⅲ級,採用隨機數字錶法,將患者隨機分為3組(每組15例):生理鹽水對照組(C組),DEX低劑量組(D1),DEX高劑量組(D2),D1和D2組于常規誘導前10 min靜脈輸註DEX負荷量1μg/kg,繼之分彆以0.2 μg· kg-1·h-1和0.5 μg·kg-1·h-1持續輸註至術畢前30 min,C組給予等容量的生理鹽水.3組術中維持腦電雙頻指數(bispectral index,BIS)值在40～49之間,分彆于痳醉誘導前(T1),取齣腫瘤時(T2),拔管時(T3),術後24 h(T4)採集靜脈血樣,測定血清中S100β及神經元特異性烯醇化酶(neuron-specific enolase,NSE)的濃度,且分彆于T1、T2、T3採集橈動脈及頸靜脈毬部的血樣行血氣分析,記錄併計算腦氧攝取率(cerebral extraction of O2,CEO2).觀察患者圍術期血壓、心率變化. 結果 與T1時比較,3組T2～T4時血清S100β、NSE濃度及CEO2升高(P＜0.05);T2～T4時C組血清NSE[(20.1±1.7)、(26.5±2.9)、(36.1±2.5) μg/L]與D2組血清NSE [(13.9±2.3)、(16.4±2.4)、(20.0±2.9) μg/L]比較差異有統計學意義(P＜0.05),T2±T4時C組血清S100β濃度[(0.73±0.08)、(0.86-±-0.08)、(1.17±0.20)μg/L]與D2組血清S100β濃度[(0.65±0.05)、(0.73±0.06)、(0.896±0.051) μg/L]比較差異有統計學意義(P＜0.05),C組與D1組血清NSE、S100β變化比較差異無統計學意義.T2～T3時C組CEO2[(0.36±0.03)、(0.34±0.03)],與D1組[(0.33±0.04)、(0.30±0.04)]比較差異有統計學意義(P＜0.05),與D2組[(0.32±0.04)、(0.26±0.04)]比較差異有統計學意義(P＜0.05),但D2組降低更為顯著(P＜0.01). 結論 圍術期持續輸註DEX可降低腦膜瘤患者CEO2,穩定圍術期血流動力學,產生腦保護效應,其機製可能與降低血S100β、NSE水平有關.
목적 평개염산우미탁미정(dexmedetomidine,DEX)대뇌막류환자위술기적뇌보호효응.방법 본연구채용전첨성수궤쌍맹대조설계,선택택기행뇌막류절제술환자45례,년령45세～65세,체중재55 kg～65 kg,미국마취의사협회(ASA)분급Ⅱ～Ⅲ급,채용수궤수자표법,장환자수궤분위3조(매조15례):생리염수대조조(C조),DEX저제량조(D1),DEX고제량조(D2),D1화D2조우상규유도전10 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,측정혈청중S100β급신경원특이성희순화매(neuron-specific enolase,NSE)적농도,차분별우T1、T2、T3채집뇨동맥급경정맥구부적혈양행혈기분석,기록병계산뇌양섭취솔(cerebral extraction of O2,CEO2).관찰환자위술기혈압、심솔변화. 결과 여T1시비교,3조T2～T4시혈청S100β、NSE농도급CEO2승고(P＜0.05);T2～T4시C조혈청NSE[(20.1±1.7)、(26.5±2.9)、(36.1±2.5) μg/L]여D2조혈청NSE [(13.9±2.3)、(16.4±2.4)、(20.0±2.9) μg/L]비교차이유통계학의의(P＜0.05),T2±T4시C조혈청S100β농도[(0.73±0.08)、(0.86-±-0.08)、(1.17±0.20)μg/L]여D2조혈청S100β농도[(0.65±0.05)、(0.73±0.06)、(0.896±0.051) μg/L]비교차이유통계학의의(P＜0.05),C조여D1조혈청NSE、S100β변화비교차이무통계학의의.T2～T3시C조CEO2[(0.36±0.03)、(0.34±0.03)],여D1조[(0.33±0.04)、(0.30±0.04)]비교차이유통계학의의(P＜0.05),여D2조[(0.32±0.04)、(0.26±0.04)]비교차이유통계학의의(P＜0.05),단D2조강저경위현저(P＜0.01). 결론 위술기지속수주DEX가강저뇌막류환자CEO2,은정위술기혈류동역학,산생뇌보호효응,기궤제가능여강저혈S100β、NSE수평유관.
Objective To evaluate the neuroprotective effect of dexmedetomidine (DEX) during perioperative period in patients with meningioma.Methods This was a prospective,double-blind,and placebo controlled study.Forty-five ASA Ⅱ-Ⅲ patients with meningioma aged 45 y-65 y weighing 55 kg-65 kg scheduled for elective intracranial tumor recection were enrolled and randomly divided into 3 groups(n=15):control group(group C);low-dose DEX group(group D1); high dose DEX group (group D2).DEX 1 μg/kg was infused i.v.10 min before anesthesia induction,and then was infused at a rate of 0.2 μg·kg1·h1(group D1)and 0.5 μg·kg-1 ·h-1 (group D2) until 30 min before the end of the operation.Group C received the equal volume of normal saline.Bispectral index (BIS) was maintained at 40-49.Venous blood samples were taken before intuction (T1),while the tumor was reresected (T2),extubation(T3),and 24 h after operation(T4) for determination of serum concentrations of S100β and neuron-specific enolase(NSE).Blood samples were also collected from radial artery and jugular venous bulb for blood gas analysis to calculate the cerebral extraction of O2 (CEO2).The changes of BP,HR during perioperative period were recorded.Results Compared with T1,the concentration of S100β and NSE in serum and CEO2 were significantly increased at T2-T4 in the three groups (P＜0.05).There was significant difference between group C and group D2 in the concentration of S100β and NSE in serum at T2-T4(P＜0.05).The numerical values of NSE in serum in group C were [(20.1±1.7),(26.5±2.9),(36.1±2.5) μg/L],while that of group D2 were [(13.9±2.3),(16.4±2.4),(20.0±2.9) μg/L],respectively at T2-T4.The numerical values of S100β in serum in group C were [(0.73±0.08),(0.86±0.08),(1.17±0.20) μg/L],while that of group D2 were [(0.65±0.05),(0.73±0.06),(0.896±0.051) μg/L],respectively at T2-T4.There was no significant difference in the indexes mentioned above between group C and group D1.There was significant diference in the three groups at T1-T3(P＜0.05).The numerical values of CEO2 in serum 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 Continuous infusing DEX intraoperative could decrease CEO2 and increase perioperative haemodynamic stability in patients undergoing meningioma surgery,exert neuroprotective effect.The protective mechanism may be related to the decline of the concentration of S100β,NSE in serum.
