右美托咪定对老年脑肿瘤切除患者围术期脑氧代谢的影响和脑损伤的保护作用

目的:探究右美托咪定对老年脑肿瘤切除患者围术期脑氧代谢的影响以及脑损伤的保护作用。方法:选择郑州大学附属河南省肿瘤医院于2017年至2018年期间接收的择期在全身麻醉下行脑肿瘤手术的82例老年脑肿瘤患者，ASA Ⅰ或Ⅱ级，采用简单随机分组法将其分为观察组和对照组，每组41例患者。观察组:麻醉诱导10 min前给予右美托咪定1 μg/kg,诱导后持续泵注右美托咪定0.6 μg/（kg·h），对照组给予等量的生理盐水。记录麻醉前（T0）、切皮时（T1）、手术终止时（T2）的HR和MAP,并监测T0、T2及术后24 h（T3）的颈静脉球血氧饱和度（SjvO2）、脑氧摄取率（CERO2）、血清神经元特异性烯醇化酶（NSE）、S100β蛋白（S100β）水平，同时记录麻醉药物的用量和两组术后24 h内的不良反应发生率。结果:观察组在T1、T2时的HR、MAP较对照组低（P＜0.05）;观察组于T2、T3时的SjvO2比对照组高，CERO2指标较对照组低（P＜0.05）；T2、T3时与T0时比较，观察组的NSE、S100β水平较对照组低（P＜0.05）；且观察组麻醉药物的总用量较对照组少（P＜0.05），观察组在术后24 h内的不良反应发生率低（P＜0.05）。结论:右美托咪定能够改善老年脑肿瘤切除术患者的脑氧代谢，减轻脑损伤程度，达到脑保护作用。同时减少了术中麻醉药物（七氟烷、丙泊酚）的用量；还可有效降低患者术后24 h内的不良反应发生率。

Effects of dexmedetomidine on perioperative cerebal oxygen metabolism and brain injury in elderly patients with brain tumor resection

Objective:To explore the effect of dexmedetomidine on perioperative cerebral oxygen metabolism and the protective effect of brain injury in elderly patients with brain tumor resection.Methods:82 elderly patients with brain tumor,ASAⅠorⅡ,who were received by Affiliated Cancer Hospital of Zhengzhou University from 2017 to 2018,were randomly divided into observation group and control group with 41 patients in each group.Observation group was given 1 μg/kg dexmedetomidine was given,before anesthesia induction about lomin 0.6 μg/(kg·h) dexmedetomidine was continuously pumped,and the control group was given the same amount of normal saline.The HR and Map in patients before anesthesia(T0),skin cutting(T1) and sugery completion(T2 were recorded).Blood oxygen saturation of the internal jugulao vein(SjvO2),namely brain oxygen uptake rate(CERO2),serum neuron specific enolase(NSE) and S100β protein(S100β) were measured at T0,T2 and postoperative 24 hour（T3）.At the same time,the dosage of anesthetic and the incidence of adverse reactions within T3 were recorded.Results:HR and MAP in the observation group were lower than those in the control group at T1 and T2 (P＜0.05).The level of SjvO2 in the observation group was higher than that in the control group at T2 and T3,and the level of CERO2 was lower than that in the control group(P＜0.05).The levels of NSE and S100β in the observation group were lower than those in the control group at T2 and T3 (P＜0.05).The total dosage of narcotic drugs(propofol and sevoflurane) in the observation group was lower than that in the control group (P＜0.05),and the incidence of adverse reactions in the observation group was lower within postoperative 24 hour（P＜0.05）.Conclusion:Dexmedetomidine can improve the brain oxygen metabolism,reduce the degree of brain injury,and achieve brain protection in the elderly patients undergoing brain tumor resection.At the same time,it can reduce the amount of anesthesia drugs(sevoflurane,propofol) during operation,also effectively reduce the incidence of adverse reactions within 24 hours after operation.