【摘要】 目的探讨右美托咪定在小儿肝脏手术中的应用效果。方法选取2018年7月—2020年6月在湖南省儿童医院接受肝脏肿块切除术的患儿60例,按随机数字表法将其分为D组和P组,每组各30例,D组采用右美托咪定,P组采用丙泊酚。比较两组血流动力学指标、局部脑氧饱和度（rSCO₂）及血清脑源性神经营养因子（BDNF）、S-100β、白细胞介素-10（IL-10）、肿瘤坏死因子-α（TNF-α）、超氧化物歧化酶（SOD）水平。结果两组心率（HR）及D组平均动脉压（MAP）各时间点比较差异均有统计学意义（均P <0.05）。P组T₁、T₂、T₃、T₄时间点MAP与T₀比较,差异均有统计学意义（均P <0.05）。D组T₁、T₂、T₃、T₄时间点的HR均低于同一时间点的P组;D组T₂、T₃、T₄时间点的MAP均低于同一时间点的P组;D组T₂、T₃时间点SpO₂均高于P组,差异有统计学意义（均P <0.05）。D组LrSCO₂在T₁时间点高于T₀,T₃时间点低于T₁,P组LrSCO₂在T₂、T₃时间点均低于T₀、T₁,T₄时间点高于T₃,差异有统计学意义（均P <0.05）。D组RrSCO₂在T₁时间点高于T₀,在T₂、T₃时间点均低于T₁,P组RrSCO₂在T₂、T₃时间点均低于T₀、T₁,在T₄时间点高于T₂、T₃,差异有统计学意义（均P <0.05）。D组T₁、T₂、T₃时间点的LrSCO₂、RrSCO₂均高于同一时间点的P组,差异有统计学意义（均P <0.05）。两组各时间点的BDNF水平比较差异均有统计学意义（均P <0.05）。D组S-100β水平除T₂与T₃及T₃与T₄时间点比较差异无统计学意义（P>0.05）外,其余各时间点比较差异均有统计学意义（均P <0.05）。P组S-100β水平在T₂、T₃、T₄时间点均高于T₀、T₁,在T₄时间点高于T₂、T₃,差异有统计学意义（均P <0.05）。D组T₂、T₃、T₄时间点的BDNF水平均高于同一时间点P组,S-100β水平均低于同一时间点P组,差异有统计学意义（均P <0.05）。两组IL-10、TNF-α、SOD各时间点比较差异均有统计学意义（均P <0.05）。D组T₂、T₃、T₄时间点的IL-10水平均低于同一时间点P组,D组T₁、T₂、T₃时间点的TNF-α水平均低于同一时间点P组,D组T₃、T₄时间点的SOD水平均低于同一时间点P组,差异有统计学意义（均P <0.05）。结论小儿肝脏手术中应用右美托咪定能够稳定患儿血流动力学,提高rSCO₂,降低炎症反应和氧化应激反应。更多还原

【Abstract】 Objective To investigate the application effect of dexmedetomidine in pediatric liver surgery. Methods A total of 60 children who underwent liver lumpectomy at Hu’nan Children’s Hospital from July 2018 to June 2020 were selected. According to random number table method, they were divided into group D and group P, with 30 patients in each group. Group D was treated with Dexmedetomidine, and group P was treated with Propofol. The level of hemodynamic indexes, regional cerebral oxygen saturation（rSCO2） and serum contents of brain-derived neurotrophic factor（BDNF）, S-100β, interleukin-10（IL-10）, tumor necrosis factor-α（TNF-α） and superoxide dismutase（SOD） were compared between the two groups. Results There were statistically significant differences in heart rate（HR） between the two groups and mean arterial pressure（MAP） of group D at each time point（all P < 0.05）. The differences of the MAP at T₁, T₂, T₃, T₄ time points in group P compared with T₀, with the statistically significant（all P < 0.05）. The HR of group D at T₁, T₂, T₃, T₄ time points were lower than those of group P at the same time point, the MAP of group D at T₂,T₃, T₄ time points were lower than those of group P at the same time point, SpO2 in group D were higher than those in group P at T₂, T₃ time points, and the differences were statistically significant（all P < 0.05）. LrSCO2 in group D at time point T₁ was higher than that at T₀, and at time point T₃ was lower than that at T₁, LrSCO2 in group P at time points T₂ and T₃ were lower than those at T₀ and T₁, and at time point T₄ was higher than that at T₃, the differences were statistically significant（all P < 0.05）.RrSCO₂ in group D at time point T₁ was higher than that at T₀, and at time point T₂, T₃ were lower than those at time point T₁, RrSCO₂ in group P at time points T₂ and T₃ were lower than those at T₀ and T₁, and at time point T₄ was higher than that at T₂, T₃, the differences were statistically significant（all P < 0.05）. The LrSCO2 and RrSCO₂ of group D at time points T₁, T₂ and T₃ were higher than those of group P at the same time points, and the differences were statistically significant（all P < 0.05）. There were statistically significant differences in BDNF levels between the two groups at each time point（all P < 0.05）. There were no significant differences in S-100β level at T₂ and T₃, T₃ and T₄ time points in group D（P > 0.05）, but there were significant differences at other time points in group D（P < 0.05）. The levels of S-100β in group P at time points T₂, T₃, T₄ were higher than those at time point T₀, T₁, and at time point T₄ was higher than that at time points T₂, T₃, with statistical significance（all P < 0.05）. The levels of BDNF at T₂, T₃, T₄ in group D were higher than those in group P at the same time point, and the levels of S-100β were lower than those in group P at the same time points, with statistical significance（all P < 0.05）. There were significant differences in the time points of IL-10, TNF-α and SOD between the two groups（all P < 0.05）. The levels of IL-10 at time points T₂, T₃, T₄ in group D were lower than those in group P at the same time points, the levels of TNF-α at time points T₁, T₂, T₃ in group D were lower than those in group P at the same time points, and the levels of SOD at T₃, T₄ in group D were lower than those in group P at the same time points, with statistical significance（all P < 0.05）. Conclusion The application of Dexmedetomidine in pediatric liver surgery can stabilize hemodynamics, improve local cerebral oxygen saturation, and reduce inflammatory response and oxidative stress response.更多还原