【摘要】 目的：观察右美托咪定联合丙泊酚麻醉对颧骨骨折内固定患者术后应激反应及神经功能的影响。方法：选择2019年10月-2021年10月笔者医院接受颧骨骨折内固定术的患者102例为研究对象，将患者分为对照组与观察组，每组51例。所有患者给予丙泊酚、舒芬太尼、罗库溴铵麻醉诱导，麻醉诱导后气管插管，给予丙泊酚、瑞芬太尼、罗库溴铵麻醉维持。在对照组的基础上，观察组给予右美托咪定。记录两组麻醉诱导前（T0）、麻醉后15 min(T1)、手术开始（T2）、手术完成（T3）及术后48 h(T4)的血流动力学指标[心率（Heartrate,HR）、血氧饱和度（SpO2）、平均动脉压（Meanarterial pressure,MAP）]；记录两组的苏醒时间和清醒时间；分别采用Ramsay评分和视觉模拟评分（Visualanalogscale,VAS）分别记录两组术后1 h的镇静和镇痛效果；记录两组术前、术后24 h及术后48 h氧化应激指标[血红素加氧酶-1(Heme oxygenase-1,HO-1)、丙二醛（Malondialdehyde,MDA）和超氧化物歧化酶（Superoxidedismutase,SOD)；采用放射免疫法检测血管紧张素（AngiotensinⅡ，AngⅡ）、去甲肾上腺素（Norepinephrine,NE）和醛固酮（Aldosterone,ALD）]、炎症因子指标[白细胞介素-6(Interleukin-6,IL-6)，肿瘤坏死因子-α(Tumornecrosisfactor-α,TNF-α)及C反应蛋白（C-reactiveprotein,CRP）]、神经功能指标[神经元特异性烯醇化酶（Neuron-specificenolase,NSE）、胶质纤维酸性蛋白（Glialfibrillaryacidicportein,GFAP）、Tau和β蛋白（S100β）]；记录两组围术期不良反应情况。结果：两组围术期HR、SpO2、MAP比较差异无统计学意义（P>0.05）。与对照组比，观察组的苏醒时间、清醒时间和VAS均显著降低，Ramsay评分显著升高，差异有统计学意义（P<0.05）。两组术前HO-1、MDA、SOD、AngⅡ、NE、ALD、IL-6、TNF-α、CRP、NSE、GFAP、Tau、S100β比较差异无统计学意义(P>0.05)。术后，两组HO-1、SOD均明显降低，MDA、AngⅡ、NE、ALD、IL-6、TNF-α、CRP、NSE、GFAP、Tau、S100β均明显增高；与对照组比，观察组HO-1、SOD均较高，MDA、AngⅡ、NE、ALD、IL-6、TNF-α、CRP、NSE、GFAP、Tau、S100β均较低，差异均有统计学意义（P<0.05）。与对照组比，观察组麻醉相关不良反应均显著降低，差异有统计学意义（P<0.05）。结论：右美托咪定联合丙泊酚麻醉对颧骨骨折内固定患者术后应激反应及神经功能的影响较小。更多还原

【Abstract】 Objective To investigate the effect of dexmedetomidine combined with propofol anesthesia on stress and neurological function in patients undergoing internal fixation of zygomatic fractures. Methods A total of 102 patients who received internal fixation of zygomatic fractures in our hospital from October 2019 to October 2021 were selected as the research subjects, and the patients were divided into the control group and the observation group, 51 cases in each group. All patients were given propofol, sufentanil and rocuronium bromide for anesthesia induction. After anesthesia induction, tracheal intubation was given,and propofol, remifentanil and rocuronium bromide were given for anesthesia maintenance. Based on the control group, the observation group was given dexmedetomidine. Before anesthesia induction(T0), 15 minutes after anesthesia(T1), operation start(T2), operation completion(T3) and 24 h after operation(T4),the hemodynamic indexes(HR, SpO2, MAP) of two groups were recorded. The wake-up time and wake-up time of two groups were recorded. The Ramsay score and VAS score were used to record the sedation and analgesia 1h after operation in two groups, respectively. The oxidative stress indicators(HO-1, MDA,SOD, Ang Ⅱ, NE and ALD), inflammatory factor indicators(IL-6, TNF-α, CRP), neurological function indicators(NSE, GFAP,Tau and S100β) of two groups before and after surgery were compared. The adverse reactions occurred in the perioperative period of two groups were recorded. Results There were no significant difference in HR, SpO2 and MAP in the perioperative period between the two groups(P>0.05). Compared with the control group, the wake-up time, wake-up time and VAS of the observation group were significantly decreased, the Ramsay of the observation group was significantly increased, the differences were statistically significant(P<0.05). Before surgery, there were no significant difference in the HO-1, MDA, SOD, Ang Ⅱ, NE, ALD, IL-6, TNF-α, CRP, NSE, GFAP, Tau, S100β in two groups(P>0.05). After surgery, the HO-1 and SOD were significantly decreased in two groups(P<0.05). MDA, Ang Ⅱ, NE, ALD, IL-6, TNF-α, CRP, NSE, GFAP, Tau and S100βwere significantly increased in two groups(P<0.05). Compared with the control group, HO-1 and SOD in the observation group were significantly increased(P<0.05). MDA, Ang Ⅱ, NE, ALD, IL-6, TNF-α, CRP, NSE, GFAP, Tau and S100β in the observation group were significantly decreased(P<0.05). Compared with the control group, the adverse reactions related to anesthesia in the observation group were significantly reduced(P<0.05). Conclusion Dexmedetomidine combined with propofol anesthesia has less effect on stress and neurological function in patients after internal fixation of zygomatic fractures.更多还原