Study of dexmedetomidine on perioperative cerebral oxygen metabolism and cerebral protection in patients with acute cerebral infarction undergoing arterial thrombolysis
Objective To investigate the effect of dexmedetomidine on perioperative cerebral oxygen metab-olism and cerebral protection in patients with acute cerebral infarction undergoing arterial thrombolysis.Methods 62 patients with acute cerebral infarction were selected as the research objects,all of whom re-ceived selective intra-arterial thrombolysis from January to August 2023 in the hospital.The patients were randomly divided into 2 groups,where 30 patients were in the control group and 32 patients in the dexme-detomidine group.Both of the 2 groups were given general anesthesia.The patients in dexmedetomidine group received an intravenous infusion of dexmedetomidine 1.0 μg/kg(infusion of 10 min)before the op-eration and maintained with 0.6 μg·kg-1·h-1till the end of operation.The patients in control group re-ceived the same amount of normal saline.Heart rate(HR),mean arterial pressure(MAP)and regional cerebral oxygen saturation(rScO2)were recorded before anesthesia(T0),5 min(T1),30 min(T2)and 60 min after the operation(T3)and 10 min after extubation and recovery(T4).Blood samples of 1 mL were respectively collected from radial artery and internal jugular veins bulb at T0 and postoperative 2 d(T5),and the corresponding hemoglobin(Hb),oxygen saturation(SaO2),arterial partial pressure of ox-ygen(PaO2),jugular vein oxygen saturation(SjvO2)were recorded.Cerebral oxygen uptake rate(CE-RO2)and arterial-jugular oxygen difference(Da-jvO2)were calculated.Neuron-specific enolase(NSE),S100β,nerve growth factor(NGF),brain-derived neurotrophic factor(BDNF),superoxide dismutase(SOD)and malondialdehyde(MDA)were also measured.At T4-5,the National Institutes of Health Stroke Scale(NIHSS)was used to evaluate the neurological impairment of the 2 groups.Results HR and MAP in both groups were significantly lower at T1-3 than at T0,and HR and MAP at T1-4 were signifi-cantly lower in the dexmedetomidine group than in the control group(P＜0.05).Compared with T0,rScO2 in both groups were decreased significantly at T1-3,and rScO2 in the dexmedetomidine group was significantly higher than that in the control group at T2-3(P＜0.05).SjvO2 at T5 was higher than that at T0,while CERO2 and Da-jvO2 at T5 were lower than those at T0 in both of the 2 groups(P＜0.05).Com-pared with the control group,the SjvO2 in the dexmedetomidine group was significantly increased,while CERO2 and Da-jvO2 were significantly reduced(P＜0.05).Compared with T0,NSE,S100β,BDNF and NGF was significantly higher than that at T5 in both of the 2 groups,and in addition,the levels of NSE and S100β in dexmedetomidine group were significantly lower than those in control group(P＜0.05),while the levels of BDNF and NGF in dexmedetomidine group were significantly higher than those in con-trol group(P＜0.05).Compared with T0,the levels of SOD in both groups were significantly decreased at T5,however,the levels of MDA were obviously increased.Compared with the control group at T5,the levels of SOD in the dexmedetomidine group were significantly higher,while the levels of MDA were sig-nificantly lower(P＜0.05).Compared with T4,the scores of NIHSS in both groups were significantly lower at T5,and the scores of NIHSS in the dexmedetomidine group were significantly lower than those in the control group at T5(P＜0.05).Conclusion Dexmedetomidine can effectively maintain perioperative hemodynamic stability of the patients with acute cerebral infarction undergoing arterial thrombolysis,im-prove their cerebral oxygen metabolism and protect their brain function,which is helpful for their postop-erative recovery.
万方数据
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