摘要
目的 对比分析右美托咪定联合乌拉地尔对高血压脑出血(HICH)术后拔管期氧合状态、神经功能及Toll样受体4(TLR4)、水通道蛋白4(AQP4)表达的影响.方法 前瞻性选取2022年2月至2023年2月于河北省第七人民医院HICH住院患者150例作为研究对象,患者均进行气管插管全身麻醉下行开颅血肿清除手术治疗.按照随机数字表法将患者分为对照组和研究组,每组各75例.手术结束后,研究组开始持续静脉泵注右美托咪定速率为0.5 µg·kg-1·h-1、乌拉地尔速率为3 μg·kg-1·min-1,对照组则静脉泵注乌拉地尔速率为3 μg·kg-1·min-1.比较两组患者在药物静脉泵注时(T0)、拔管时(T1)、拔管后1 h(T2)、拔管后6 h(T3)、拔管后12 h(T4)以及拔管后24 h(T5)的氧合状态[心率、平均肺动脉(MAP)、呼吸频率以及动脉血氧饱和度(SpO2)],T0、T1、T4的脑氧代谢和脑糖代谢[脑动静脉血液的葡萄糖含量差(A-VDG)和脑氧摄取率(CERO2)]变化水平,拔管前(t0)以及拔管后1 d(t1)、拔管后3 d(t2)、拔管后7 d(t3)神经功能缺损情况[国立卫生研究院卒中量表(NIHSS)]、t0、t1的血清TLR4和AQP4含量以及拔管后30 d内不良反应发生情况.结果 T,～T5时,研究组患者的心率、MAP水平均显著低于对照组,而呼吸频率、SpO2的水平均显著高于对照组,差异均有统计学意义(P＜0.05).T1、T4、T5时,研究组患者的A-VDG和CERO2水平均显著高于对照组,差异均有统计学意义(P＜0.05).t1、t2、t3时,研究组患者的NIHSS评分均显著低于对照组,差异均有统计学意义(P＜0.05).研究组的拔管后总不良反应发生率为14.67％,显著低于对照组(37.33％),差异有统计学意义(P＜0.05).结论 右美托咪定联合乌拉地尔在HICH术后拔管期具有良好的镇静和神经保护作用,可以改善患者的氧合状态、神经功能、脑氧代谢和脑糖代谢,显著降低TLR4以及AQP4蛋白表达,以减轻脑损伤和神经功能障碍的情况.
Abstract
Objective Comparative analysis of the effects of dexmedetomidine combined with urapidil on oxygenation status,neurological function,and expression of Toll like receptor 4(TLR4)and aquaporin 4(AQP4)during extubation after surgery for hypertensive intracerebral hemorrhage(HICH).Methods A total of 150 patients with H1CH hospitalized in the Seventh People s Hospital of Hebei Province from February 2022 to February 2023 were prospectively selected as the research objects.All patients underwent craniotomy hematoma removal surgery under gen-eral anesthesia with endotracheal intubation.According to the random number table method,patients were divided into two groups:the control group and the study group,with 75 patients in each group.After the surgery,the study group began continuous intravenous infusion of dexmedeto-midine at a rate of 0.5 μg·kg-1·h-1 and urapidil at a rate of 3 μg·kg-1·min-1,while the control group received intravenous infusion of urapidil at a rate of 3 μg·kg-1·min-1.The oxygenation status[heart rate,mean pulmonary artery(MAP),arterial oxygen saturation(SpO2)]at the time of drug intravenous infusion(T0),extubation(T1),1 h after extubation(T2),6 h after extubation(T3),12 h after extu-bation(T4)and 24 h after extubation(T5),the changes of cerebral oxygen metabolism and cerebral glucose metabolism[glucose content differ-ence in cerebral arteriovenous blood(A-VDG)and cerebral oxygen extraction rate(CERO2)]at T0,T1 and T4 were observed.The neurologi-cal deficits[national institutes of health stroke scale(NIHSS)]before extubation(t0)and 1 d(t1),3d(t2)and 7 d(t3)after extubation,se-rum TLR4 and AQP4 levels at t0 and t1,and adverse reactions within 30 d after extubation were compared between the two groups.Results At T1-T5,the heart rate and MAP level of the study group were significantly lower than those of the control group,while the respiratory rate and SpO2 level were significantly higher than those of the control group,the differences were statistically significant(P＜0.05).At T1,T4 and T5,the levels of A-VDG and CERO2 in the study group were significantly higher than those in the control group,and the differences were statistically significant(P＜0.05).At t1,t2 and t3,the NIHSS scores of the study group were significantly lower than those of the control group,the differ-ences were statistically significant(P＜0.05).The total incidence of adverse reactions after extubation in the study group was 14.67％,which was significantly lower than that in the control group(37.33％),and the difference was statistically significant(P＜0.05).Conclusion The combination of dexmedetomidine and urapidil has good sedative and neuroprotective effects during the extubation period after surgery for hyperten-sive intracerebral hemorrhage.It can improve the patients oxygenation state,neurological function,cerebral oxygen metabolism,and cerebral glu-cose metabolism,significantly reduce the expression of TLR4 and AQP4 proteins,thus alleviate brain injury and neurological dysfunction.
NETL
NSTL
万方数据