查看更多>>摘要：目的 探讨脑外伤患者开颅术后镇痛麻醉方案的构建及对患者脑保护作用和神经损伤标志物的影响。 方法 选取2021年2月至2022年1月在山西省人民医院择期行开颅手术患者99例，按照随机数字表法将患者分为A、B、C 3组，每组33例。A组不给予右美托咪定，B、C组在麻醉诱导前，均静脉泵注右美托咪定1 μg/kg的负荷剂量，然后分别以0.2、0.4 μg·kg-1·h-1速率进行泵注，至术后24 h停止。观察3组患者围手术期心率（HR）、血压、呼吸频率（RR）、血氧饱和度（SpO2）等血流动力学指标。采用酶联免疫吸附法（ELISA）检测血清神经损伤标志物水平[神经元特异性烯醇化酶（NSE）、S-100β蛋白、诱导型一氧化氮合酶（iNOS）]。采用颅内压监测仪动态测定颅内压，计算脑氧摄取率（CERO2）。记录3组不良反应发生情况。 结果 T0时，3组血流动力学指标、血清神经损伤标志物水平、颅内压、CERO2水平比较，差异均无统计学意义（均P>0.05）。随着麻醉时间推移，3组在不同时间点比较，平均动脉压、HR、NSE、S-100β、iNOS、颅内压、CERO2水平差异有统计学意义（均P<0.05），其中C组变化幅度比A、B组更大；而RR、SpO2差异均无统计学意义（均P>0.05）。3组不良反应发生率比较，差异无统计学意义（P>0.05）。 结论 开颅术后患者采用右美托咪定复合氢吗啡酮具有较好的镇痛效果，具有脑保护作用，可改善神经损伤标志物水平，术后不良反应发生较少，且对呼吸没有显著影响，尤其是0.4 μg的右美托咪定复合氢吗啡酮效果最佳。 Objective To formulate an analgesic anesthesia program after craniotomy in patients with brain trauma, and to investigate its role in brain protection and effect on nerve injury markers. Methods Ninety-nine patients who underwent elective craniotomy in Shanxi Provincial People's Hospital between February 2021 and January 2022 were included and divided into groups A, B and C according to random number table (n=33 each). While group A was not on any dosing of dexmedetomidine, groups B and C were given intravenous dexmedetomidine via an infusion pump at a loading dose of 1μg/kg before anesthesia induction, and then the pump infusion was continued at a rate of 0.2 and 0.4 μg·kg-1·h-1, respectively, until 24 hours after surgery. Perioperative heart rate (HR), blood pressure, respiratory rate (RR), SpO2 and other hemodynamic parameters were observed in the three groups. Serum nerve injury markers [neuron-specific enolase (NSE), S-100β protein, inducible nitric oxide synthase (iNOS) ] were detected by enzyme linked immunosorbent assay (ELISA). Intracranial pressure monitor was used to measure intracranial pressure dynamically, with calculation of the cerebral oxygen extraction ratio (CERO2). The occurrence of adverse reactions in the three groups was recorded. Results At 20 min prior to anesthesia induction (T0), there were no significant differences in hemodynamics, nerve injury markers, intracranial pressure and CERO2 among the three groups (P>0.05). Over the duration of anesthesia, the three groups varied statistically in the mean arterial pressure, HR, NSE, S-100β, iNOS, intracranial pressure, and CERO2 at any other time point (allP<0.05), with greater changes in these indicators found for group C compared with groups A and B, but no significant differences in RR and SpO2 were noted among groups (both P>0.05). The incidence of adverse reactions was comparable among the three groups (P>0.05) . Conclusion After craniotomy, dexmedetomidine combined with hydromorphone may lead to good analgesic outcome and brain protection, improvement in the level of nerve injury markers, less postoperative adverse reactions, and no significant impact on respiration. These benefits are more prominent with 0.4 μg dexmedetomidine combined with hydromorphone.
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