摘要
目的:考察右美托咪定对颈椎手术患者神经元损伤指标、炎性因子及脊髓功能的影响。方法:选取2015年5月-2017年11月于我院行全麻颈椎手术的患者112例,按随机数字表法分为对照组和右美托咪定组,各56例。两组患者均采用全凭静脉麻醉方式进行麻醉维持;右美托咪定组患者于麻醉维持前静脉泵注盐酸右美托咪定注射液负荷剂量0.8μg/kg,泵注时间>10 min,随后以0.4μg/(kg·h)的速度持续泵注直至手术前30 min。观察两组患者麻醉诱导前(T_0)、手术结束后1 h(T_1)、手术结束后1 d(T_2)、手术结束后7 d(T_3)的神经元损伤指标[神经胶质纤维酸性蛋白(GFAP)、神经元特异性烯醇化酶(NSE)、基质金属蛋白酶9(MMP-9)]和血清炎性因子[肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、IL-10]水平,术前及术后第7天的颈椎日本矫形科学学会(JOA)评分以及术后第1、7天的视觉模拟量表(VAS)评分,并记录不良反应发生情况。结果:两组各有3例患者脱落,各有53例完成本研究。T_0时点,两组患者神经元损伤指标和血清炎性因子水平比较,差异均无统计学意义(P>0.05);T_1~T_3时点,两组患者上述指标均显著高于T_0时点,且右美托咪定组患者GFAP、NSE、MMP-9、TNF-α、IL-6水平显著低于对照组,IL-10水平显著高于对照组,差异均有统计学意义(P<0.05)。术前或术后第1天,两组患者JOA评分及VAS评分比较,差异均无统计学意义(P>0.05);术后第7天,两组患者JOA评分显著升高,VAS评分显著降低,差异均有统计学意义(P<0.05),但组间比较差异均无统计学意义(P>0.05)。两组患者均未见明显不良反应发生。结论:在麻醉维持前加用右美托咪定可改善颈椎手术患者的血清炎性因子水平,并一定程度地减轻患者脊髓和神经元损伤,同时不影响用药的安全性。
OBJECTIVE：To investigate the effects of dexmedetomidine on neuron injury indexes,inflammatory factors andspinal cord function of cervical operation patients. METHODS：Totally of 112 patients underwent cervical operation of generalanesthesia in our hospital during May 2015 to Nov. 2017 were divided into control group and dexmedetomidine group accordingto random number table,with 56 cases in each group. Anesthesia of both groups was totally maintained by intravenous anesthesia.Dexmedetomidine group was given intravenous infusion of Dexmeimidine hydrochloride injection with loading dose of 0.8 μg/kgand injection time of more than 10 min before anesthesia maintenance,and then was continuously pumped to 30 min beforeoperation at the rate of 0.4 μ g/（kg·h）. The levels of neuron injury indexes（GFAP,NSE,MMP-9）and inflammatory factors（TNF-α,IL-6,IL-10）of 2 groups were observed before anesthesia induction（T0）,1 h after operation（T1）,1 d after operation（T2）,7 d after operation （T3）. Japanese Orthopedics Academy （JOA） scores of cervical vertebra were observed in 2 groupsbefore operation and 7 d after operation,and VAS scores were also observed in 2 groups 1 d and 7 d after operation. Theoccurrence of ADR was recorded. RESULTS：Each 3 patients of 2 groups withdrew from the study,and each 53 patients of 2groups completed the study. There was no statistical significance in neuron injury indexes or serum levels of inflammatory factorsbetween 2 groups at T0 （P〉0.05）. At T1-T3,above indexes of both groups were significantly higher than at T0;the levels ofGFAP,NSE,MMP-9,TNF-α and IL-6 in dexmedetomidine group were significantly lower than control group,while the level ofIL-10 was significantly higher than control group,with statistical significance（P〈0.05）. There was no statistical significance inJOA score or VAS score between 2 groups before operation or 1 d after operation（P〉0.05）. Seven days after operation,JOAscores of 2 groups were increased significantly,while VAS scores were decreased significantly,with statistical significance（P〈0.05）; but there was no statistical significance between 2 groups （P〉0.05）. No obvious ADR was found in 2 groups.CONCLUSIONS： Additional use of dexmedetomidine before anesthesia maintenance can improve the serum levels ofinflammatory factors in cervical operation patients,and relieve neuron spinal cord and injury to certain extent,but would notinfluence the safety of drug use.
作者
唐松江
王凌浩
TANG Songjiang;WANG Linghao(Dept. of Anesthesiology,the First Affiliated Hospital of Guiyang College ofTCM,Guiyang 550001,China)
出处
《中国药房》
CAS
北大核心
2018年第10期1388-1391,共4页
China Pharmacy
关键词
右美托咪定
颈椎手术
神经元
脊髓
损伤
炎性因子
Dexmedetomidine
Cervical operation
Neuron
Spinal cord
Injury
Inflammatory factor
