杨雪;栗付民;韩灵龙;

• 1:许昌市中心医院

摘要(Abstract)：

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(hsCRP)、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。

关键词(KeyWords)： 颅脑损伤;血肿清除术;去骨瓣减压术;右美托咪定;利多卡因;炎性应激反应

Abstract:

Keywords:

基金项目(Foundation): 许昌市科技计划项目(编号：20190213187)

作者(Authors): 杨雪;栗付民;韩灵龙;

参考文献(References)：

• [1]ZHANG H M,LIU P,JIANG C,et al.Notch signaling inhibitor DAPT provides protection against acute craniocerebral injury[J].PLoS One,2018,13(2):e0193037.DOI:10.1371/journal.pone.0193037.eCollection 2018.
• [2]ZOU Y.Effects of Programmed Analgesia and Sedation Combined with Moderate Hyperventilation on Recovery Time and Cognitive Function in Patients with Severe Craniocerebral Injury[J].J Clin Res,2020,37(1):12-14,17.DOI:10.3969/j.issn.1671-7171.2020.01.005.
• [3]KIL'DYUSHOV E M,EGORVA E V,KUZIN A N,et al.The diagnostic potential of computed tomography for the purpose of forensic medical examination of a craniocerebral injury[J].Sud Med Ekspert,2018,61(4):19-23.DOI:10.17116/sudmed 201861419.
• [4]HUANG G,GUO X,LIU X,et al.The regulation effect of dexmedetomidine on nerve function,cerebral oxygen metabolism and inflammatory factor in craniocerebral operation patients[J].J Bengbu Med Coll,2018,43(5):27-30.DOI:10.13898/j.cnki.issn.1000-2200.2018.05.005.
• [5]CHEN M,PENG S,OU C,et al.Application of dexmedetomidine combined with sufentanil in anesthesia of craniocerebral surgery[J].Pract J Clin Med,2020,17(1):161-164.DOI:CNKI:SUN:YYLC.0.2020-01-048.
• [6]ZHANG M H,ZHOU X M,CUI J Z,et al.Neuroprotective effects of dexmedetomidine on traumatic brain injury:Involvement of neuronal apoptosis and HSP70 expression[J].Mol Med Rep,2018,17(6):8079-8086.DOI:10.3892/mmr.2018.8898.
• [7]LEE S.Dexmedetomidine:Present and future directions[J].Korean J Anesthesiol,2019,72(4):323-330.DOI:10.4097/kja.19259.Epub 2019 Jun 21.
• [8]WANG Y,WANG C,ZHANG D,et al.Dexmedetomidine Protects Against Traumatic Brain Injury-Induced Acute Lung Injury in Mice[J].Med Sci Monit,2018,24:4961-4967.DOI:10.12659/MSM.908133.
• [9]LI F,WANG X,DENG Z,et al.Dexmedetomidine reduces oxidative stress and provides neuroprotection in a model of traumatic brain injury via the PGC-1αsignaling pathway[J].Neuropeptides,2018,72:58-64.DOI:10.1016/j.npep.2018.10.004.
• [10]ZHENG B,ZHANG S,YING Y,et al.Administration of Dexmedetomidine inhibited NLRP3 inflammasome and microglial cell activities in hippocampus of traumatic brain injury rats[J].Biosci Rep,2018,38(5):BSR20180892.DOI:10.1042/BSR20180892.
• [11]李钊,祁景,王艮卫.右美托咪定对重症颅脑损伤术后患者脑氧代谢率和脑血流的影响[J].中国实用神经疾病杂志,2020,23(13):1165-1168.DOI:10.12083/SYSJ.2020.13.264.
• [12]YIN D,ZHOU S,XU X,et al.Dexmedetomidine attenuated early brain injury in rats with subarachnoid haemorrhage by suppressing the inflammatory response:The TLR4/NF-κB pathway and the NLRP3 inflammasome may be involved in the mechanism[J].Brain Res,2018,1698:1-10.DOI:10.1016/j.brainres.2018.05.040.
• [13]谢凌燕,郭桂珍,刘晓军.右美托咪定对急性颅脑损伤患者脑功能及血流动力学的影响[J].中国实用神经疾病杂志,2019,22(21):2389-2393.DOI:10.12083/SYSJ.2019.21.391.
• [14]WU J,VOGEL T,GAO X,et al.Neuroprotective effect of dexmedetomidine in a murine model of traumatic brain injury[J].Sci Rep,2018,8(1):4935.DOI:10.1038/s41598-018-23003-3.
• [15]LI F,WANG X,ZHANG Z,et al.Dexmedetomidine Attenuates Neuroinflammatory-Induced Apoptosis after Traumatic Brain Injury via Nrf2 signaling pathway[J].Ann Clin Transl Neurol,2019,6(9):1825-1835.DOI:10.1002/acn3.50878.
• [16]MINKIS K,WHITTINGTON A,ALAM M.Dermatologic surgery emergencies:Complications caused by systemic reactions,high-energy systems,and trauma[J].J Am Acad Dermatol,2016,75(2):265-284.DOI:10.1016/j.jaad.2015.11.054.
• [17]CARELLI S,DE PASCALE G,FILETICI N,et al.The place of dexmedetomidine light sedation in patients with acute brain injury[J].Crit Care,2019,23(1):340.DOI:10.1186/s13054-019-2637-9.
• [18]SINGH S,CHOUHAN RS,BINDRA A,et al.Comparison of effect of dexmedetomidine and lidocaine on intracranial and systemic hemodynamic response to chest physiotherapy and tracheal suctioning in patients with severe traumatic brain injury[J].J Anesth,2018,32(4):518-523.DOI:10.1007/s00540-018-2505-9.
• [19]GAO J,WEI L,XU G,et al.Effects of dexmedetomidine vs sufentanil during percutaneous tracheostomy for traumatic brain injury patients:A prospective randomized controlled trial[J].Medicine(Baltimore),2019,98(35):e17012.DOI:10.1097/MD.0000000000017012.
• [20]GONG J,ZHANG R,SHEN L,et al.The brain protective effect of dexmedetomidine during surgery for paediatric patients with congenital heart disease[J].J Int Med Res,2019,47(4):1677-1684.DOI:10.1177/0300060518821272.
• [21]GREEN P G,ALVAREZ P,LEVINE J D.Topical Tetrodotoxin Attenuates Photophobia Induced by Corneal Injury in the Rat[J].J Pain,2015,16(9):881-886.DOI:10.1016/j.jpain.2015.06.002.
• [22]ZHAI M,LIU C,LI Y,et al.Dexmedetomidine inhibits neuronal apoptosis by inducing Sigma-1 receptor signaling in cerebral ischemia-reperfusion injury[J].Aging(Albany NY),2019,11(21):9556-9568.DOI:10.18632/aging.102404.
• [23]BERECZKI D JR,PETO N,SZEGEDI N.Transient deficits after inadvertent intrathecal trigger-point injection with lidocaine[J].Neurology,2016,87(8):848-849.DOI:10.1212/WNL.0000000000003015.
• [24]LETSON H L,DOBSON G P.Adenosine,lidocaine,and Mg2+(ALM)resuscitation fluid protects against experimental traumatic brain injury[J].J Trauma Acute Care Surg,2018,84(6):908-916.DOI:10.1097/TA.0000000000001874.
• [25]SKROBIK Y,DUPREY M S,HILL N S,et al.Low-dose Nocturnal Dexmedetomidine Prevents ICU Delirium:ARandomized,Placebo-controlled Trial[J].Am J Respir Crit Care Med,2018,197(9):1147-1156.DOI:10.1164/rccm.201710-1995OC.
• [26]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.DOI:10.1007/s11910-018-0873-z.
• [27]ZHU Y,LI S,LIU J,et al.Role of JNK Signaling Pathway in Dexmedetomidine Post-Conditioning-Induced Reduction of the Inflammatory Response and Autophagy Effect of Focal Cerebral Ischemia Reperfusion Injury in Rats[J].Inflammation,2019,42(6):2181-2191.DOI:10.1007/s10753-019-01082-2.
• [28]SINGH S,CHOUHAN R S,BINDRA A,et al.Comparison of effect of dexmedetomidine and lidocaine on intracranial and systemic hemodynamic response to chest physiotherapy and tracheal suctioning in patients with severe traumatic brain injury[J].J Anesth,2018,32(4):518-523.DOI:10.1007/s00540-018-2505-9.
• [29]DA SILVA P S L,DE AGUIAR V E,FONSECA M CM.Does Tracheal Lidocaine Instillation Reduce Intracranial Pressure Changes After Tracheal Suctioning in Severe Head Trauma?A Prospective,Randomized Crossover Study[J].Pediatr Crit Care Med,2019,20(4):365-371.DOI:10.1097/PCC.0000000000001817.
• [30]JEONG Y J,KIM H J,KWON H,et al.The Use of Topical Lidocaine Gel During Intermaxillary Fixation Procedure[J].J Craniofac Surg,2016,27(5):e475-e477.DOI:10.1097/SCS.0000000000002790.
• [31]ARGENT A C.Endotracheal Lidocaine Installation,Endotracheal Suction,and Intracranial Pressure in Patients With Traumatic Brain Injury-Assessing the Impact[J].Pediatr Crit Care Med,2019,20(4):387-388.DOI:10.1097/PCC.0000000000001848.
• [32]WU Z,XUE H,ZHANG Y,et al.Dexmedetomidine alleviates neurobehavioral impairments and myelination deficits following lipopolysaccharide exposure in early postnatal rats[J].Life Sci,2020,263:118556.DOI:10.1016/j.lfs.2020.118556.
• [33]KARACA O,DOGAN G.The effects of dexmedetomidine in increased intestinal permeability after traumatic brain injury:An experimental study[J].Ulus Travma Acil Cerrahi Derg,2020,26(1):15-20.DOI:10.14744/tjtes.2019.49768.
• [34]KANG F,TANG C,HAN M,et al.Effects of Dexmedetomidine-Isoflurane versus Isoflurane Anesthesia on Brain Injury After Cardiac Valve Replacement Surgery[J].J Cardiothorac Vasc Anesth,2018,32(4):1581-1586.DOI:10.1053/j.jvca.2017.11.028.
• [35]JIANG W W,WANG Q H,LIAO Y J,et al.Effects of dexmedetomidine on TNF-αand interleukin-2 in serum of rats with severe craniocerebral injury[J].BMCAnesthesiol,2017,17(1):130.DOI:10.1186/s12871-017-0410-7.
• [36]SHEN M,WANG S,WEN X,et al.Dexmedetomidine exerts neuroprotective effect via the activation of the PI3K/Akt/mTOR signaling pathway in rats with traumatic brain injury[J].Biomed Pharmacother,2017,95:885-893.DOI:10.1016/j.biopha.2017.08.125.
• [37]JIANG L,HU M,LU Y,et al.The protective effects of dexmedetomidine on ischemic brain injury:A metaanalysis[J].J Clin Anesth,2017,40:25-32.DOI:10.1016/j.jclinane.2017.04.003.
• [38]ENDESFELDER S,MAKKI H,VON HAEFEN C,et al.Neuroprotective effects of dexmedetomidine against hyperoxia-induced injury in the developing rat brain[J].PLoS One,2017,12(2):e0171498.DOI:10.1371/journal.pone.0171498.
• [39]HUMBLE S S,WILSON L D,LEATH T C,et al.ICUsedation with dexmedetomidine after severe traumatic brain injury[J].Brain Inj,2016,30(10):1266-1270.DOI:10.1080/02699052.2016.1187289.
• [40]PAJOUMAND M,KUFERA J A,BONDS B W,et al.Dexmedetomidine as an adjunct for sedation in patients with traumatic brain injury[J].J Trauma Acute Care Surg,2016,81 (2):345-351.DOI:10.1097/TA.0000000000001069.