国际麻醉学与复苏杂志   2013, Issue (5): 5-5
    
盐酸右美托咪啶对脑膜瘤患者围术期的脑保护效应
李爱梅, 石翊飒, 张喜洋, 高瑞萍, 李雅楠, 韩杰1()
1.甘肃省兰州大学第二临床医学院
The neuroprotective effect of dexmedetomidine during periopererative period in patients with meningioma
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摘要：

目的 评价盐酸右美托咪啶（dexmedetomidine, DEX）对脑膜瘤患者围术期的脑保护效应。方法 本研究采用前瞻性随机双盲对照设计，选择择期行脑膜瘤切除术患者45例，年龄45岁～65岁，体重在55 kg～65 kg， 美国麻醉医师协会（ASA）分级Ⅱ～Ⅲ级，采用随机数字表法，将患者随机分为3组（每组15例）：生理盐水对照组（C组），盐酸右美托咪啶低剂量组（D1），盐酸右美托咪啶高剂量组（D2），D1和D2组于常规诱导前10 min静脉输注DEX负荷量1 μg/kg，继之分别以0.2 μg•kg-1•h-1和0.5 μg•kg-1•h-1持续输注至术毕前30 min，C组给与等容量的生理盐水。3组术中维持脑电双频指数值(bispectral index, BIS)在40～49之间，分别于麻醉诱导前（T1），取出肿瘤时（T2），拔管时（T3），术后24 h（T4）采集静脉血样，测定血清中S100B及神经元特异性烯醇化酶（neuron-specific enolase, NSE）的浓度，且分别于T1 、T2 、T3采集桡动脉及颈静脉球部的血样行血气分析，记录并计算脑氧摄取率（cerebral extraction of O2 , CEO2）。观察患者围术期血压、心率变化。结果 与T 1时比较，3组T2～T4时血清S100B、NSE浓度及CEO2升高(P<0.05)；T2～T4时C组血清NSE[(20.1±1.7)、(26.5±2.9)、(36.1±2.5) μg/L]与D2组血清NSE [(13.9±2.3)、(16.4±2.4)、(20.0±2.9) μg/L]比较差异有统计学意义(P<0.05)，T2～T4时C组血清S100B浓度[(0.73±0.08)、(0.86±0.08)、(1.17±0.20) μg/L] 与D2组血清S100B浓度[(0.65±0.05)、(0.73±0.06)、(0.896±0.051) μg/L]比较差异有统计学意义(P<0.05)，C组与D1组血清NSE、 S100B变化比较差异无统计学意义。T2～T3时C组CEO2[(0.36±0.03)、(0.34±0.03)]，与D1 组[(0.33±0.04)、( 0.30±0.04)]比较差异有统计学意义(P<0.05)，与D2组[（0.32±0.04）、（0.26±0.04）]比较差异有统计学意义(P<0.05)，但D2组降低更为显著 (P<0.01)。结论 围术期持续输注DEX可降低脑膜瘤患者CEO2，稳定围术期血流动力学，产生脑保护效应，其机制可能与降低血S100B、NSE水平有关。
关键词： 盐酸右美托咪啶；神经保护；脑膜瘤；脑氧摄取率
Abstract:

Objective To evaluate the neuroprotective effect of dexmedetomidine（DEX） during perioperative period in patients with meningioma. Methods This was a prospective, double-blind, and placebo controlled study．Forty-five ASAⅡ-Ⅲ patients with meningioma aged 45 y-65 y weighing 55 kg-65 kg scheduled for elective intracranial tumor recection were enrolled and randomly divided into 3 groups (n=15 each): control group (group C)；low-dose dexmedetomidine group（group D1）； high dose dexmedetomidine group (group D2). DEX 1 μg/kg was infused i.v. 10 min before anesthesia induction, and then was infused at a rate of 0.2 μg•kg-1•h-1（group D1）and 0.5 μg•kg-1•h-1（group D2）until 30 min before the end of the operation. Group C received the equal volume of normal saline. Bispectral index (BIS) was maintained at 40-49.Venous blood samples were taken before intuction (T1), while the tumor was reresected (T2), extubation (T3), and 24 h after operation (T4) for determination of serum concentrations of S100B and neuron-specific enolase (NSE). Blood samples were also collected from radial artery and jugular venous bulb for blood gas analysis to calculate the cerebral extraction of O2 (CEO2). The changes of BP, HR during perioperative period were recorded. Results Compared with T1, the concentration of S100B and NSE in serum and CEO2 were significantly increased at T2 – T4 in the three groups (P<0.05). There was significant difference between group C and group D2 in the concentration of S100B and NSE in serum at T2 – T4 (P <0.05). The numerical values of NSE in serum in group C were [(20.1±1.7), (26.5±2.9), (36.1±2.5) μg/L], while that of group D2 were [(13.9±2.3), (16.4±2.4), (20.0±2.9) μg/L], respectively at T2 – T4. The numerical values of S100B in serum in group C were [(0.73±0.08), (0.86±0.08), (1.17±0.20) μg/L], while that of group D2 were [(0.65±0.05), (0.73±0.06), (0.896±0.051) μg/L], respectively at T2 – T4. There was no significant difference in the indexes mentioned above between group C and group D1. There was significant diference in the three groups at T1– T3( P <0.05). The numerical values of CEO2 in serum in group C were [(0.36±0.03),(0.34±0.03)], while that of group D1 were [(0.33±0.04), (0.30±0.04)], and group D2 were [(0.32±0.04), (0.26±0.04)], respectively at T2 – T3. Conclusions Continuous infusing DEX intraoperative could decrease CEO2 and increase perioperative haemodynamic stability in patients undergoing meningioma surgery, exert neuroprotective effect. The protective mechanism may be related to the decline of the concentration of S100β, NSE in serum.
Key words: Dexmedetomidine； Neuroprotection；Meningioma；Cerebral extraction of O2.