右美托咪定对脑膜瘤患者胶质纤维酸性蛋白及肌酸激酶脑型同工酶的影响

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

The effects of dexmedetomidine on glial fibrillary acidic protein and brain typeisoenzyme of creatine phosphokinase during perioperative period in patients with meningioma

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?