【摘要】 目的通过测定开颅手术中应用右美托咪定(DEX)的患者血清IL-6、TNF-α水平和手术前后24h简易精神状态检查表(MMSE)评分,探讨DEX对开颅手术患者炎性反应和认知功能的干预作用。方法选取45例择期行开颅手术的患者,随机分入对照组、DEX0.5组(DEX负荷剂量和维持剂量分别为0.5μg/kg和0.5μg·kg-1·h-1)和DEX1.0组(DEX负荷剂量和维持剂量分别为1.0μg/k和1.0μg·kg-1·h-1)。分别于手术前、后24h对患者进行MMSE评分,计算手术前后MMSE评分的差值(ΔMMSE),采用放射免疫法检测患者术前24h(T0)、切开硬脑膜后(T1)、手术结束时(T2)和术后24h(T3)各时间点的血清IL-6、TNF-α水平。结果 DEX0.5组和DEX1.0组术后24h的MMSE评分均显著高于对照组同时间点(P值均<0.05),ΔMMSE均显著低于对照组(P值均<0.05);DEX0.5组与DEX1.0组间术后24h的MMSE评分和ΔMMSE的差异均无统计学意义(P值均>0.05)。对照组术后24h的MMSE评分显著低于同组术前24h(P<0.05)。DEX0.5组T2、T3时间点和DEX1.0组T1、T2、T3时间点的血清IL-6和TNF-α水平均显著低于对照组同时间点(P值均<0.05),DEX1.0组T2、T3时间点的血清IL-6和TNF-α水平均显著低于DEX0.5组同时间点(P值均<0.05)。3组T1、T2、T3时间点的血清IL-6和TNF-α水平均显著高于同组T0时间点(P值均<0.05),3组T2、T3时间点的血清IL-6和TNF-α水平均显著高于同组T1时间点(P值均<0.05),3组T2时间点的血清IL-6水平均显著高于同组T3时间点(P值均<0.05)。结论 DEX能够降低行开颅手术患者术后血清IL-6和TNF-α水平,减轻术后炎性反应,提高MMSE评分。更多还原

【Abstract】 Objective To detect the levels of serum interleukin-6(IL-6)and tumor necrosis factor-alpha(TNF-α)and the change of mini mental status examination(MMSE)scores when dexmedetomidine(DEX)was applied during craniotomy,and to explore the effect of DEX on inflammatory response and cognitive function.Methods Forty-five patients scheduled for craniotomy were randomly divided into 3groups:control group,DEX0.5 group(loading dose and maintenance dose of DEX was 0.5 μg/kg and 0.5 μg·kg-1·h-1,respectively), DEX1.0 group(loading dose and maintenance dose of DEX was 1.0 μg/kg and1.0μg·kg-1·h-1,respectively).MMSE scores were assessed 24 hbefore and after surgery.Serum IL-6and TNF-αlevels were determined by radioimmunoassay at the following time points:24hbefore operation(T0),after endocranium was cut open(T1),the end of the surgery(T2)and 24 hafter operation(T3).Results MMSE scores of DEX0.5group and DEX1.0group were significantly higher than that of control group 24 hafter surgery(both P<0.05),whileΔMMSE of DEX0.5group and DEX1.0group were significantly lower than that of control group(both P<0.05).There were no significant differences in MMSE scores orΔMMSE between DEX0.5group and DEX1.0group 24 hafter surgery(both P>0.05).MMSE score at T3 was significantly lower than that at 24 h in the control group(P<0.05).The levels of serum IL-6and TNF-αof DEX0.5group at T2 and T3and those of DEX1.0group at T1,T2 and T3 were significantly lower than those of control group(all P<0.05).The levels of serum IL-6and TNF-αof DEX1.0group were significantly lower than those of DEX0.5group at T2 and T3(all P <0.05).In the three groups,IL-6and TNF-αlevels at T1,T2 and T3 were significantly higher than those at T0(all P<0.05);IL-6and TNF-αlevels at T2 and T3 were significantly higher than those at T1(all P<0.05);IL-6and TNF-αlevels at T2 were significantly higher than those at T3(all P<0.05).Conclusion Dexmedetomidine can decrease serum IL-6and TNF-α,reduce postoperative inflammatory reaction and increase MMSE scores in patients undergoing craniotomy.更多还原