右美托咪定与利多卡因对颅脑损伤患者术后炎性应激反应及脑损伤的影响

目的探讨右美托咪定与利多卡因对颅脑损伤手术患者术后炎性应激反应、脑损伤的影响。方法选取2018-03—2020-05许昌市中心医院颅脑损伤手术患者102例,以简单随机化法分为观察组(n=51)、对照组(n=51)。对照组在麻醉诱导前予以1.5 mg/kg利多卡因,术中应用2 mg/(kg·h)速度静脉维持到术毕,观察组在对照组基础上麻醉诱导前予以0.6μg/kg右美托咪定输注15 min,而后以0.2μg/(kg·h)速度维持到术毕。对比2组不良反应、术后1周认知功能障碍发生情况与麻醉诱导前(T0)、插管后即刻(T1)、开颅时(T2)、术毕拔管时(T3)血流动力学指标平均动脉压(MAP)、心率(HR)]水平,T0、T3、术后12 h(T4)、术后24 h(T5)血清炎症因子指标肿瘤坏死因子-α(TNF-α)、超敏-C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)]、应激反应指标血糖(GLU)、肾上腺素(E)、皮质醇(Cor)]、脑损伤指标神经元特异性烯醇化酶(NSE)、S-100β蛋白]水平,T0、术后3 d、术后1周认知功能评分(MMSE)。结果观察组T1、T2、T3时MAP、HR水平低于对照组(P<0.05)。2组T3、T4、T5时血清TNF-α、hs-CRP、IL-6、GLU、E、Cor、NSE、S-100β蛋白水平较T0时提高,但观察组低于对照组(P<0.05)。2组术后3 d、术后1周的MMSE评分较T0时降低,但观察组高于对照组(P<0.05)。2组不良反应发生率相比,差异无统计学意义(P>0.05)。观察组术后1周认知功能障碍发生率(5.88%)低于对照组(19.61%,P<0.05)。结论右美托咪定结合利多卡因应用于颅脑损伤手术患者可稳定术中血流动力学,减轻机体炎症应激反应与脑损伤、认知功能损害,且安全性良好。

Effect of combination of dexmedetomidine and lidocaine on postoperative inflammatory stress response and brain injury in patients undergoing craniocerebral injury surgery

Objective To investigate the effect of combination of dexmedetomidine and lidocaine on postoperative inflammatory stress response and brain injury in patients with craniocerebral injury surgery.Methods From March 2018 to May 2020,102 patients with craniocerebral injury in our hospital were selected and divided into observation group(n=51)and control group(n=51)by simple randomization method.The control group was given 1.5 mg/kg lidocaine before induction of anesthesia,and 2 mg(/kg·h)was applied intravenously until the end of the operation.On the basis of the control group,the observation group was given 0.6μg/kg dexmedetomidine infusion for 15 minutes before induction of anesthesia,and then maintained at a rate of 0.2μg(/kg·h)until the end of the operation.The adverse reactions,the occurrence of cognitive dysfunction in the first week after the operation,hemodynamic indexes(mean arterial pressure(MAP),heart rate(HR))levels before induction of anesthesia(T0),immediately after intubation(T1),at the time of craniotomy(T2),and extubation after surgery(T3),serum inflammatory factor indexes(tumor necrosis factor-α(TNF-α),high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6)),stress response indicators(blood sugar(GLU),adrenaline(E),cortisol(Cor)),brain damage indicators(neuron-specific enolase(NSE),S-100βprotein)levels at T0,T3,12 h after surgery(T4),and 24h after surgery(T5),cognitive function score(MMSE)at T0,3 days after surgery,and 1 week after surgery were compared between the two groups.Results The levels of MAP and HR at T1,T2,and T3 in the observation group were lower than those in the control group(P<0.05).Serum TNF-α,hs-CRP,IL-6,GLU,E,Cor,NSE,and S-100βprotein levels in the two groups at T3,T4,and T5 were higher than those at T0,but the observation group was lower than the control group(P<0.05).The MMSE scores of the 2 groups at 3 days and 1 week after operation were lower than those at T0,but the observation group was higher than the control group(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).The incidence of cognitive dysfunction in the observation group at 1 week after surgery was 5.88%lower than that of the control group(19.61%,P<0.05).Conclusion Dexmedetomidine combined with lidocaine can stabilize intraoperative hemodynamics in patients undergoing craniocerebral injury surgery,reduce the body’s inflammatory stress response,brain injury,and cognitive impairment,and has good safety.