右美托咪定及七氟烷复合芬太尼对幕上脑肿瘤患者血清NSE、S-100β、MDA和SOD含量及脑氧供需平衡的影响
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摘要
目的:分析右美托咪定及七氟烷复合芬太尼对幕上脑肿瘤患者脑氧供需平衡及代谢的影响。方法:采用前瞻性研究,将幕上脑肿瘤患者(90例)堆积分为2组,对照组在麻醉诱导前给予生理盐水,观察组给予右美托咪定。记录麻醉诱导前(T1)、气管插管时(T2)、硬脑膜切开时(T3)、肿瘤取出时(T4)、术毕(T5)、术后24 h(T6)患者脑氧供需平衡指标,即脑氧摄取率(CERO_2)、颈内静脉球部血氧饱和度(SjvO_2)、静脉血氧含量差(Ca-jvO_2)、动脉血血氧含量(CaO_2);对比各时间点患者脑能量代谢指标,即脑乳酸氧指数(LOI)、葡萄糖摄取率(GluER)、脑乳酸生成率(Lac PR)水平。对比两组患者各时间点颈内静脉球部血清NSE、S-100β、MDA、SOD水平。结果:T3、T4、T5、T6时观察组CERO_2、Ca-jvO_2水平较对照组低,SjvO_2水平较对照组高,均为P <0. 05。观察组T4、T5时LacPR较对照组低,P <0. 05,其余指标对比无统计学差异,P> 0. 05。T3、T4、T5、T6时观察组S-100β、NSE、MDA水平较对照组低,SOD水平较对照组高,均为P <0. 05。结论:右美托咪定能使幕上脑肿瘤患者围术期脑氧供需平衡得到改善,降低自由基水平和多种脑损伤特异性蛋白水平,有效保护脑组织。
Objective: To analyze the effects of dexmedetomidine and sevoflurane on the supply and demand balance and metabolism of cerebral oxygen in patients with supratentorial brain tumor. Methods: A prospective study was conducted in which patients with supratentorial brain tumors( 90 cases) were divided into 2 groups. The control group received saline before induction of anesthesia and the observation group received dexmedetomidine. Record the cerebral oxygen supply-demand balance in patients before anesthesia induction( T1),tracheal intubation( T2),dura incision( T3),tumor removal( T4),surgery completion( T5),and postoperative 24 h( T6),namely brain oxygen uptake rate( CERO_2),Blood oxygen saturation of the internal jugular vein( SjvO_2),Poor venous oxygen content( Ca-jvO_2),arterial blood oxygen content( CaO_2). Comparison of patients at each time point of the brain energy metabolism index,the brain oxygenation index( LOI),glucose uptake rate( GluER),and brain lactate production rate( Lac PR) levels. The levels of serum NSE,S-100β,MDA,and SOD in the jugular veins of the two groups at each time point were compared. Results: The levels of CERO_2 and Ca-jvO_2 in the observation group were lower than those in the control group at T3,T4,T5 and T6. The level of SjvO_2 was higher in the observation group than in the control group,both being P < 0. 05. Lac PR was lower in the observation group than in the control group at T4 and T5( P <0. 05). There was no significant difference in other indicators between the observation group and the control group( P> 0. 05). The levels of S-100β,NSE,and MDA in the observation group were lower than those in the control group at T3,T4,T5,and T6. SOD levels were higher in the observation group than in the control group,both being P < 0. 05.Conclusion: Dexmedetomidine can improve perioperative cerebral oxygen supply and demand balance in patients with supratentorial brain tumors,reduce free radical levels and multiple brain injury-specific protein levels,and effectively protect brain tissue.
Objective: To analyze the effects of dexmedetomidine and sevoflurane on the supply and demand balance and metabolism of cerebral oxygen in patients with supratentorial brain tumor. Methods: A prospective study was conducted in which patients with supratentorial brain tumors( 90 cases) were divided into 2 groups. The control group received saline before induction of anesthesia and the observation group received dexmedetomidine. Record the cerebral oxygen supply-demand balance in patients before anesthesia induction( T1),tracheal intubation( T2),dura incision( T3),tumor removal( T4),surgery completion( T5),and postoperative 24 h( T6),namely brain oxygen uptake rate( CERO_2),Blood oxygen saturation of the internal jugular vein( SjvO_2),Poor venous oxygen content( Ca-jvO_2),arterial blood oxygen content( CaO_2). Comparison of patients at each time point of the brain energy metabolism index,the brain oxygenation index( LOI),glucose uptake rate( GluER),and brain lactate production rate( Lac PR) levels. The levels of serum NSE,S-100β,MDA,and SOD in the jugular veins of the two groups at each time point were compared. Results: The levels of CERO_2 and Ca-jvO_2 in the observation group were lower than those in the control group at T3,T4,T5 and T6. The level of SjvO_2 was higher in the observation group than in the control group,both being P < 0. 05. Lac PR was lower in the observation group than in the control group at T4 and T5( P <0. 05). There was no significant difference in other indicators between the observation group and the control group( P> 0. 05). The levels of S-100β,NSE,and MDA in the observation group were lower than those in the control group at T3,T4,T5,and T6. SOD levels were higher in the observation group than in the control group,both being P < 0. 05.Conclusion: Dexmedetomidine can improve perioperative cerebral oxygen supply and demand balance in patients with supratentorial brain tumors,reduce free radical levels and multiple brain injury-specific protein levels,and effectively protect brain tissue.
引文
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[10]Liu Yuanchun,Song Xiaowen,Yang Hong,et al. Effect of dexmedetomidine on arousal effect and stress response during tumor resection in brain functional area[J]. Hebei Medical,2016,22(7):1087-1090.[刘远春,宋小文,杨红,等.右美托咪定对脑功能区肿瘤切除术术中唤醒效果及应激反应的影响[J].河北医学,2016,22(7):1087-1090.]
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[12]Jiang Bo,Song Tieying,Zhao Xiaobo,et al. Effects of dexmedetomidine combined with sevoflurane anesthesia on cerebral oxygen metabolism in children undergoing elective surgery in Department of Neurosurgery[J]. Journal of Hebei Medical University,2016,37(10):1222-1226.[姜博,宋铁鹰,赵晓波,等.右美托咪定联合七氟醚麻醉对神经外科择期手术患儿脑氧代谢的影响[J].河北医科大学学报,2016,37(10):1222-1226.]
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[14]Hong Yurong,Wang Tian,Song Xin,et al. Effects of dexmedetomidine on hemodynamics and postoperative recovery in elderly patients with brain tumors[J]. Chinese Journal of Clinical Neuroscience,2015,23(6):630-634.[洪羽蓉,王田,宋昕,等.右美托咪啶对老年脑肿瘤患者手术过程中血流动力学及术后恢复的影响[J].中国临床神经科学,2015,23(6):630-634.]
[15]D'Elia A,Tropeano MP,Maiola V,et al. The etiology of lowgrade gliomas:pathological and clinical considerations about radiation-induced low-grade gliomas[J]. Neurological Sciences,2015,36(7):1091-1095.
[16]Guo Yuda,Dai Hanying,Chen Like,et al. Effects of different doses of dexmedetomidine on SEP combined with MEP in monitoring patients in Department of neurosurgery[J]. Journal of Practical Medicine,2017,33(10):1669-1673.[郭余大,戴寒英,陈立科,等.不同剂量右美托咪定对SEP联合MEP监测神经外科手术患者的影响[J].实用医学杂志,2017,33(10):1669-1673.]
[17]Guo Yuda,Dai Hanying,Zhou Xiaoping,et al. Dexmedetomidine for motor evoked potential monitoring department of neurosurgery operation patient safety and feasibility[J]. In Clinical Anesthesiology,2016,32(5):434-437.[郭余大,戴寒英,周小平,等.右美托咪定用于运动诱发电位监测神经外科手术患者的安全性和可行性[J].临床麻醉学杂志,2016,32(5):434-437.]
[18]Yang Mingming,Zhong Shuisheng,Xie Fan,et al. Effects of dexmedetomidine on postoperative cognitive dysfunction in elderly patients with benign brain tumors[J]. Guangdong Medicine,2016,37(17):2654-2657.[杨明明,钟水生,谢凡,等.右美托咪定对老年患者良性脑肿瘤术后认知功能障碍的影响[J].广东医学,2016,37(17):2654-2657.]
[19]Zhan Lifang,Li Guoqiang,Shan Reai,et al. Effects of dexmedetomidine on glucose and lactic acid in patients with supratentorial tumor resection[J]. Guangdong Medicine,2015,21(13):2101-2103.[占丽芳,李国强,单热爱,等.右美托咪定对脑幕上肿瘤切除术患者葡萄糖和乳酸的影响[J].广东医学,2015,21(13):2101-2103.]
[20]Arnautovic Aska,Billups Catherine,Broniscer Alberto,et al. Delayed diagnosis of childhood low-grade glioma:causes,consequences,and potential solutions[J]. Child's Nervous System,2015,31(7):1067-1077.
[2]Zheng Yongping,Guo Wei,Zhang Zongze,et al. Effects of different doses of dexmedetomidine on stress response during general anesthesia for thoracotomy patients[J]. Journal of Wuhan University(Medical Science),2015,36(2):312-316.[郑勇萍,郭伟,张宗泽,等.不同剂量的右美托咪定对全麻开胸手术患者苏醒期应激反应的影响[J].武汉大学学报(医学版),2015,36(2):312-316.]
[3]Zhang Yunghui,Gao Jingui,Zhang Shan,et al. Brain protective effect of dexmedetomidine on craniotomy under general anesthesia in patients with craniocerebral injury[J]. Chinese Journal of Anesthesiology,2015,35(1):30-32.[张韫辉,高金贵,张山,等.右美托咪定对颅脑损伤患者全麻下开颅术时的脑保护作用[J].中华麻醉学杂志,2015,35(1):30-32.]
[4]Zhou Gang,Ying Tingting,Ye Yongqing,et al. Effects of dexmedetomidine on serum NSE,S-100 gy,and endolipids in patients with acute brain injury[J]. Chinese Clinical Pharmacology and Therapeutics,2016,21(11):1292-1295.[周纲,应婷婷,叶永青,等.右美托咪定对急性脑损伤患者血清NSE、S-100β、内脂素的影响[J].中国临床药理学与治疗学,2016,21(11):1292-1295.]
[5]Xie Xiaojuan,Li Qianhui,Song Shaotuan,et al. Effects of dexmedetomidine combined with fentanyl and seven halothane on serum NSE,S-100 beta,SOD and MDA contents and cerebral oxygen supply and demand balance in patients with supratentorial brain tumors[J]. Journal of Huazhong University of Science and Technology(Medical Science),2017,46(1):76-79,93.[谢小娟,李前辉,宋绍团,等.右美托咪定复合芬太尼及七氟烷对幕上脑肿瘤患者血清NSE、S-100β、SOD和MDA含量及脑氧供需平衡的影响[J].华中科技大学学报(医学版),2017,46(1):76-79,93.]
[6]Muhatall Gecity,Nurmemtine Maikomti,Chocoti Abdurahman,et al. The effect of dexmedetomidine on brain protection in patients undergoing craniocerebral tumor surgery[J]. Medical Review,2016,22(22):4496-4499.[穆哈塔尔·热西提,努尔买买提江·买合木提,肖柯提·阿不都热合曼,等.右美托咪定对颅脑肿瘤手术患者的脑保护效果[J].医学综述,2016,22(22):4496-4499.]
[7]Wang Yuebin,Sun Guangyun,He Changyou,et al. Effects of dexmedetomidine and propofol anesthesia on brain protection in elderly patients undergoing brain tumor surgery[J]. Modern Cancer Medicine,2016,24(17):2793-2795.[王跃斌,孙广运,何常佑,等.右美托咪定与异丙酚麻醉对老年脑肿瘤手术患者脑保护效应对比[J].现代肿瘤医学,2016,24(17):2793-2795.]
[8]Ma Hongmei,Guo Yingying,Wu Zhihong,et al. Effect of intravenous infusion of dexmedetomidine on inflammatory factors,cerebral oxygen metabolism and cognitive function in patients undergoing craniocerebral operation[J]. Practical Journal of Cardio Cerebral and Pulmonary Vascular Diseases,2016,24(11):35-39.[马红梅,郭莹莹,吴智宏,等.静脉泵注右美托咪定对颅脑手术患者炎性因子、脑氧代谢及认知功能的影响研究[J].实用心脑肺血管病杂志,2016,24(11):35-39.]
[9]Zhou Luyang,Gu Wei,Liu Yun,et al. Effects of dexmedetomidine on cellular immune function and prognosis in patients with brain tumor surgery[J]. Modern Biomedical Progress,2017,17(28):5484-5488.[周路阳,顾伟,刘芸,等.右美托咪定对脑肿瘤手术患者细胞免疫功能以及预后影响的研究[J].现代生物医学进展,2017,17(28):5484-5488.]
[10]Liu Yuanchun,Song Xiaowen,Yang Hong,et al. Effect of dexmedetomidine on arousal effect and stress response during tumor resection in brain functional area[J]. Hebei Medical,2016,22(7):1087-1090.[刘远春,宋小文,杨红,等.右美托咪定对脑功能区肿瘤切除术术中唤醒效果及应激反应的影响[J].河北医学,2016,22(7):1087-1090.]
[11]Surbeck Werner,Herbet Guillaume,Duffau Hugues,et al. Sexuality after surgery for diffuse low-grade glioma[J]. Neuro-oncology,2015,17(4):574-579.
[12]Jiang Bo,Song Tieying,Zhao Xiaobo,et al. Effects of dexmedetomidine combined with sevoflurane anesthesia on cerebral oxygen metabolism in children undergoing elective surgery in Department of Neurosurgery[J]. Journal of Hebei Medical University,2016,37(10):1222-1226.[姜博,宋铁鹰,赵晓波,等.右美托咪定联合七氟醚麻醉对神经外科择期手术患儿脑氧代谢的影响[J].河北医科大学学报,2016,37(10):1222-1226.]
[13]Zhang Qian,Zhang Jiuxiang,Wang Shaoshuang,et al. Dexmedetomidine combined with remifentanil for conscious craniotomy[J].Department of Neurosurgery,Chinese Journal of Disease Research,2016,15(6):523-525.[张倩,张久祥,王韶双,等.右美托咪定联合瑞芬太尼用于清醒开颅手术的麻醉体会[J].中华神经外科疾病研究杂志,2016,15(6):523-525.]
[14]Hong Yurong,Wang Tian,Song Xin,et al. Effects of dexmedetomidine on hemodynamics and postoperative recovery in elderly patients with brain tumors[J]. Chinese Journal of Clinical Neuroscience,2015,23(6):630-634.[洪羽蓉,王田,宋昕,等.右美托咪啶对老年脑肿瘤患者手术过程中血流动力学及术后恢复的影响[J].中国临床神经科学,2015,23(6):630-634.]
[15]D'Elia A,Tropeano MP,Maiola V,et al. The etiology of lowgrade gliomas:pathological and clinical considerations about radiation-induced low-grade gliomas[J]. Neurological Sciences,2015,36(7):1091-1095.
[16]Guo Yuda,Dai Hanying,Chen Like,et al. Effects of different doses of dexmedetomidine on SEP combined with MEP in monitoring patients in Department of neurosurgery[J]. Journal of Practical Medicine,2017,33(10):1669-1673.[郭余大,戴寒英,陈立科,等.不同剂量右美托咪定对SEP联合MEP监测神经外科手术患者的影响[J].实用医学杂志,2017,33(10):1669-1673.]
[17]Guo Yuda,Dai Hanying,Zhou Xiaoping,et al. Dexmedetomidine for motor evoked potential monitoring department of neurosurgery operation patient safety and feasibility[J]. In Clinical Anesthesiology,2016,32(5):434-437.[郭余大,戴寒英,周小平,等.右美托咪定用于运动诱发电位监测神经外科手术患者的安全性和可行性[J].临床麻醉学杂志,2016,32(5):434-437.]
[18]Yang Mingming,Zhong Shuisheng,Xie Fan,et al. Effects of dexmedetomidine on postoperative cognitive dysfunction in elderly patients with benign brain tumors[J]. Guangdong Medicine,2016,37(17):2654-2657.[杨明明,钟水生,谢凡,等.右美托咪定对老年患者良性脑肿瘤术后认知功能障碍的影响[J].广东医学,2016,37(17):2654-2657.]
[19]Zhan Lifang,Li Guoqiang,Shan Reai,et al. Effects of dexmedetomidine on glucose and lactic acid in patients with supratentorial tumor resection[J]. Guangdong Medicine,2015,21(13):2101-2103.[占丽芳,李国强,单热爱,等.右美托咪定对脑幕上肿瘤切除术患者葡萄糖和乳酸的影响[J].广东医学,2015,21(13):2101-2103.]
[20]Arnautovic Aska,Billups Catherine,Broniscer Alberto,et al. Delayed diagnosis of childhood low-grade glioma:causes,consequences,and potential solutions[J]. Child's Nervous System,2015,31(7):1067-1077.