张海生;张泳;李淑萍;

• 1:郑州市第九人民医院

摘要(Abstract)：

目的观察右美托咪定复合七氟醚在脑胶质瘤术中的应用价值。方法选择郑州市第九人民医院2018-01-2020-01收治的76例脑胶质瘤患者为研究对象,随机数表法分为对照组和观察组各38例。对照组采用芬太尼复合七氟醚麻醉,观察组在对照组基础上采用右美托咪定麻醉。分别于术前1 d、术后1 d、术后3 d采用美国国立卫生研究院脑卒中量表(NIHSS)评估2组神经功能;分别于入室时(T0)、切开硬脑膜时(T2)及术毕时(T3)检测2组血清INOS及PI3K水平;记录2组用药不良反应。结果观察组术后1 d、3 d时的NIHSS评分均低于对照组,差异有统计学意义(P<0.05);2组T2时的INOS及PI3K水平均较T0、T1时升高,而观察组T2时的INOS及PI3K水平均低于对照组,差异有统计学意义(P<0.05);2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论脑胶质瘤术中应用右美托咪定复合七氟醚麻醉安全性好,且可保护患者神经功能,减轻术中脑损伤。

关键词(KeyWords)： 脑胶质瘤;右美托咪定;七氟醚;神经功能;诱导型一氧化氮合酶;磷脂酰肌醇3激酶;脑损伤

Abstract:

Keywords:

基金项目(Foundation): 河南省医学科技攻关计划联合共建项目（编号：LHGJ20191130）

作者(Authors): 张海生;张泳;李淑萍;

参考文献(References)：

• [1]JACOBS D I,FUKUMURA K,BAINBRIDGE M N,et al.Elucidating the molecular pathogenesis of glioma:integrated germline and somatic profiling of a familial glioma case series[J].Neuro Oncol,2018,20(12):1625-1633.
• [2]CAHILL D,TURCAB S.Origin of Gliomas[J].Semin Neurol,2018,38(1):5-10.
• [3]ONIZUKA H,MASUI K,KOMORI T.Diffuse gliomas to date and beyond 2016 WHO Classification of Tumours of the Central Nervous System[J].Int J Clin Oncol,2020,25(6):997-1003.
• [4]FERRIS S P,HOFMANN J W,SOLOMON D A,et al.Characterization of gliomas:from morphology to molecules[J].Virchows Arch,2017,471(1):257-269.
• [5]HERVEY-JUMPER S L,BERGER M S.Insular glioma surgery:an evolution of thought and practice[J].JNeurosurg,2019,130(1):9-16.
• [6]BUSH N A O,CHANG S M,BERGER M S.Current and future strategies for treatment of glioma[J].Neurosurg Rev,2017,40(1):1-14.
• [7]HERVEY-JUMPER S L,BERGER M S.Insular glioma surgery:an evolution of thought and practice[J].JNeurosurg,2019,130(1):9-16.
• [8]GAO C,HE X F,XU Q R.Sevoflurane downregulates insulin-like growth factor-1 to inhibit cell proliferation,invasion and trigger apoptosis in glioma through the PI3K/AKT signaling pathway[J].Anticancer Drugs,2019,30(7):e0744.
• [9]DONG J,ZENG M,JI N,et al.Impact of Anesthesia on Long-term Outcomes in Patients With Supratentorial High-grade Glioma Undergoing Tumor Resection:ARetrospective Cohort Study[J].J Neurosurg Anesthesiol,2020,32(3):227-233.
• [10]MOLINA E S,SCHIPMANN S,MUELLER I,et al.Conscious sedation with dexmedetomidine compared with asleep-awake-asleep craniotomies in glioma surgery:an analysis of 180 patients[J].J Neurosurg,2018,129(5):1223-1230.
• [11]YANG H,CHEN Y D,YAN H,et al.Effects of dexmedetomidine on glioma cells in the presence or absence of cisplatin[J].J Cell Biochem,2020,121(1):723-734.
• [12]LAAKSONEN L,KALLIOINEN M,LANGSJO J,et al.Comparative effects of dexmedetomidine,propofol,sevoflurane,and S-ketamine on regional cerebral glucose metabolism in humans:a positron emission tomography study[J].Br J Anaesth,2018,121(1):281-290.
• [13]WEN P Y,REARDON D A.Neuro-oncology in 2015:Progress in glioma diagnosis,classification and treatment[J].Nat Rev Neurol,2016,12(2):69-70.
• [14]DAABISS M.American Society of Anaesthesiologists physical status classification[J].Indian J Anaesth,2011,55(2):111-115.
• [15]NAESS H,KURTZ M,THOMASSEN L,et al.Serial NIHSS scores in patients with acute cerebral infarction[J].Acta Neurol Scand,2016,133(6):415-420.
• [16]MILLER A M,SHAH R H,PENTSOVA E I,et al.Tracking tumour evolution in glioma through liquid biopsies of cerebrospinal fluid[J].Nature,2019,565(7741):654-658.
• [17]FOSTER C H,MORONE P J,CIHEN-GADOL A.Awake craniotomy in glioma surgery:is it necessary[J].J Neurosurg Sci,2019,63(2):162-178.
• [18]SANAI N,BERGER M S.Surgical oncology for gliomas:the state of the art[J].Nat Rev Clin Oncol,2018,15(2):112-125.
• [19]ESEONU C I,RINCON-TORROELLA J,REFAEYK,et al.Awake Craniotomy vs Craniotomy Under General Anesthesia for Perirolandic Gliomas:Evaluating Perioperative Complications and Extent of Resection[J].Neurosurgery,2017,81(3):481-489.
• [20]邹旭丽，耿红芳，王旭.右美托咪定用于脑膜瘤切除术患者的麻醉效果及安全性分析[J].中国实用神经疾病，2018,21(8):888-890.
• [21]薛延召，董铁立.右美托咪定对神经外科手术患者局部脑氧饱和度和术后认知功能的影响[J].中国实用神经疾病，2018,21(23):2617-2622.
• [22]WANG C Y,DATOO T,ZHAO H L,et al.Midazolam and Dexmedetomidine Affect Neuroglioma and Lung Carcinoma Cell Biology In Vitro and In Vivo[J].Anesthesiology,2018,129(5):1000-1014.
• [23]LEE S.Dexmedetomidine:present and future directions[J].Korean J Anesthesiol,2019,72(4):323-330.
• [24]THOMAS D D,WINK D A.NOS2 as an Emergent Player in Progression of Cancer[J].Antioxid Redox Signal,2017,26(17):963-965.
• [25]KIM A Y,SHIN H M,KIM J S,et al.Anti-inflammatory Effects of Aster yomena Extracts by the Suppression of Inducible Nitric Oxide Synthase Expression[J].Biomed Sci Lett,2017,23(2):104-110.
• [26]FAN Q W,AKSOY O,WONG R A,et al.A Kinase Inhibitor Targeted to m TORC1 Drives Regression in Glioblastoma[J].Cancer Cell,2017,31(3):424-435.
• [27]LI M,LIANG R F,WANG X,et al.BKM120sensitizes C6 glioma cells to temozolomide via suppression of the PI3K/Akt/NF-κB/MGMT signaling pathway[J].Oncol Lett,2017,14(6):6597-6603.
• [28]HALL S E,UPTON R M O,MCLAUGHLIN E A,et al.Phosphoinositide 3-kinase/protein kinase B (PI3K/AKT) and Janus kinase/signal transducer and activator of transcription (JAK/STAT) follicular signalling is conserved in the mare ovary[J].Reprod Fertil Dev,2018,30(4):624-633.
• [29]CARR Z J,CIOS T J,POTTER K F,et al.Does Dexmedetomidine Ameliorate Postoperative Cognitive Dysfunction?A Brief Review of the Recent Literature[J].Curr Neurol Neurosci Rep,2018,18(10):64.
• [30]WANG N,WANG M Y.Dexmedetomidine suppresses sevoflurane anesthesia-induced neuroinflammation through activation of the PI3K/Akt/m TOR pathway[J].BMC Anesthesiol,2019,19(1):134.