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右美托咪啶对肝移植患者围术期脑功能的保护作用研究
右美托咪啶对肝移植患者围术期脑功能的保护作用研究
单智铭,许奕欣,修欢欢,张 勇,赵 悦,徐康清

深圳市人民医院麻醉科,深圳 518020
Perioperative neural protection of dexmedetomidine on patients undergoing liver transplantation
(Department of Anesthesiology, Shenzhen People's Hospital, Shenzhen 518020, China)

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起始页:58

摘要:[摘要] 目的:探讨右美托咪啶对肝移植患者围术期脑功能的保护作用及其机制。方法:选取我院拟行同种异体肝移植术的患者80例,按随机数字表法随机分成2组:右美托咪啶组(D组)和对照组(C组),每组40例。D组患者于麻醉诱导前10 min静脉滴注负荷量右美托咪啶1 μg?kg-1,10 min滴注完后继续以0.5 μg?kg-1?h-1泵注维持至术毕;C组患者则以同等体积生理盐水代替右美托咪啶。分别于麻醉诱导前(T1)、切肝前(T2)、无肝期10 min(T3)、新肝期10 min(T4)及术毕时(T5)采集桡动脉及颈静脉血行血气分析,计算动脉血氧含量、脑动-静脉血氧含量差和脑氧摄取率,采集静脉血样,测定血清中S100β、神经元特异性烯醇化酶(NSE)的浓度,记录患者血流动力学改变,记录患者手术前后简易智能精神状态检查量表(MMSE)评分。结果:D组患者在无肝期及新肝期的血压和心率改变均较C组平稳;D组患者脑氧摄取率在无肝期及新肝期均明显低于C组;D组患者在无肝期及新肝期其血清中S100β及NSE均明显低于C组;D组患者其术后MMSE评分明显高于C组(P<0.05)。结论:肝移植患者围术期持续使用右美托咪啶能够在一定程度上使围术期血流动力学趋于平稳,减少脑神经氧摄取率,抑制脑细胞S100β及NSE的释放,降低术后神经功能障碍的发生。

关键词:[关键词] 右美托咪啶;肝移植;脑功能保护;S100β;神经元特异性烯醇化酶

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Abstract:[Abstract] Objective: To evaluate the perioperative neural protection of dexmedetomidine on patients undergoing liver transplantation. Methods: Eighty patients undergoing liver transplantaion in our hospital were randomly divided into two groups: group D and group C. Patients in group D were administered with dexmedetomidine at 1 μg?kg-1 by bolus injection in 10 min, followed by iv pumping at the rate of 0.5 μg?kg-1?h-1 till the end of surgery. Patients in group C were administered normal saline instead of dexmedetomidine. Arterial blood samples were obtained before anesthesia (T1), before hepatectomy (T2), non-liver period (T3), new liver period (T4), and at the end of surgery (T5) to analyze CaO2, Da-jvO2 and CERO2, and venous blood samples were collected to measure S100β and neuron specific enolase (NSE). Hemodynamics during surgery was recorded. MMSE scale were obtained before and after surgery. Results: The patients in group D showed more stable hemodynamics than those in group C during T3 and T4. The CERO2 values of patients in group D were much lower than those in group C during T3 and T4. The S100β and NSE levels of patients in group D were much lower than those in group C during T3 and T4. The MMSE scales of patients in Group D were much higher than those in group C after surgery. Conclusion: Dexmedetomidine can partially stabilize the hemodynamics, decrease cerebral oxygen extraction rate, inhibit the release of S100β and NSE, and improve patients' neural function after liver transplantation surgery.

Key words:[Key words] dexmedetomidine; liver transplantation; neural protection; S100β; neuron specific enolase

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