摘要
目的:探讨右美托咪定对重度颅脑损伤患者血清内脂素(visfatin)和高敏C-反应蛋白(Hs-CRP)的影响。方法:选取2011年8月至2013年8月我院收治的72例拟行急诊手术的重度颅脑损伤患者为研究对象,随机分为右美托咪定治疗组(n=36例)和对照组(n=36例),治疗组患者于麻醉诱导前至术后3 d给予静脉输注右美托咪定治疗0.5μg/(k·h),对照组给予等剂量0.9%氯化钠溶液处理;分别于麻醉诱导前(T0)、术毕(T1)、术后第1天(T2)、术后第3天(T3)、术后第5天(T4)及术后第7天(T5)抽取静脉血测定血清内脂素、HsCRP,并记录术后6个月的格拉斯哥预后量表(GOS)评分等级情况。结果:1与T0比较,2组患者的血清内脂素、Hs-CRP水平在T2-T4明显增高(P<0.05),治疗组在T5接近T0,而对照组仍明显高于T0(P<0.05);与对照组比较,治疗组T2-T5时的血清内脂素、Hs-CRP水平明显降低(P<0.05);2经Spearman相关分析显示:血清内脂素水平与Hs-CRP水平呈现正相关(r=0.462,P=0.000),与白细胞计数亦呈正相关(r=0.221,P=0.028);3多因素Logistic回归分析显示:血清内脂素水平(OR=1.733,P<0.05)以及Hs-CRP(OR=3.184,P<0.05)与患者预后不良呈正相关(6个月后的GOS评分<3分);4治疗组治疗6个月后的GOS评分中的预后较好率(为88.9%)明显高于对照组(为66.7%)(x2=5.143,P=0.0233)。结论:血清内脂素与颅脑损伤后的炎症反应密切相关,其与Hs-CRP可能为重度颅脑外伤患者预后不良的高危因素。右美托咪定可明显降低血清内脂素和Hs-CRP水平从而抑制炎症反应,改善患者预后。
Objective：To explore the effect of dexmedetomidine on serumvisfatin and high-sensitive C-reactive protein in patients with severe craniocerebral trauma. Methods：Seventy-two cases of severe cranio-cerebral trauma patients received emergency operation from August 2011 to August 2013 in our hospital were selected as research subjects, the patients were randomly divided into treatment group （n=36） and control group （n=36）, patients in treatment group received intravenous injection of dexmedetomidine 0.5μg/（kg？h） from the time before anesthesia induction to postoperative 3 days, patients in control group were given equal volume of saline. Venous blood samples were collected to determine serumvisfatin, Hs-CRP level before anesthesia induc-tion （T0）, at the end of the surgery （T1）, on postoperative 1 day （T2）, 3 days （T3）, 5 days （T4） and 7 days （T5） re-spectively. Glasgow outcome scale （GOS） score was recorded after surgery for six months. Results：①Compared with T0, serumvisfatin and Hs-CRP of two groups were signiifcantly higher at T2-T4 （P〈0.05）, both indexes of treatment group at T5 were similar with those at T0, while both indexes of control group at T5 were signiifcantly higher than those at T0 （P〈0.05）. Compared with control group, serumvisfatin and Hs-CRP of treatment group were significantly lower at T2-T5 （P〈0.05）. ②Spearman correlation analysis showed that the serum visfatin level was positively correlated with Hs-CRP （r=0.462, P=0.000）, and also positively correlated with WBC count （r=0.221, P=0.028）.③Multi-factor logistic regression analysis showed that serum visfatin （OR=1.733, P〈0.05） and Hs-CRP （OR=3.184, P〈0.05） were positively correlated with poor prognosis （GOS score after six months〈3 points）.④Rate of good prognosis in treatment group （88.9%） was signiifcantly higher than that in the control group （66.7%） in term of GOS score after six months （x2=5.143, P=0.233）. Conclusion：Serum visfatin is closely related to inlfammatory response after brain injury and it companied with Hs-CRP are high risk factors for poor prognosis in patients with severe craniocerebral injury. Dexmedetomidine can obviously reduce serum visfatin and Hs-CRP levels and thus inhibit inlfammation response so as to improve the prognosis of patients.
出处
《温州医学院学报》
CAS
2015年第2期126-130,共5页
Journal of Wenzhou Medical College
基金
浙江省临床科研基金项目(2012ZYC-A82)
关键词
右美托咪定
颅脑损伤
内脂素
高敏C-反应蛋白
炎症反应
dexmedetomidine
craniocerebral trauma
visfatin
high-sensitive C-reactive protein
inlfamm-atory response
