摘要
目的:探讨右美托咪定联合瑞芬太尼、丙泊酚对神经外科手术麻醉效果及血清Nogo-A、低氧诱导因子1α(HIF-1α)表达的影响。方法:收集2015年1月至2018年6月在陕西省榆林市第一医院接受神经外科治疗的100例患者,随机分为对照组和观察组,每组50例。对照组采用丙泊酚、瑞芬太尼麻醉,观察组在此基础上联合右美托咪定;比较两组临床指标、不良事件发生情况、术中知晓情况和唤醒应答能力;比较两组入室时(T0)、唤醒前30 min(T1)、唤醒即刻(T2)、唤醒后5 min(T3)、唤醒结束后继续麻醉10 min(T4)的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)、镇静评分(Ramsay评分);比较两组入室时、术毕、术后3 d和术后1周血清Nogo-A mRNA、Nogo-A、HIF-1α、血管内皮生长因子(VEGF)蛋白的表达。结果:两组唤醒前麻醉时间、顺阿曲库铵用量、术中知晓情况、心动过速发生率比较,差异无统计学意义(P>0.05),观察组唤醒时间、自主呼吸恢复时间、丙泊酚用量、瑞芬太尼用量、躁动、呛咳发生率显著低于对照组(P<0.05);观察组应答满意率显著高于对照组(90.00%vs74.00%,P<0.05)。两组HR、MAP、SpO2变化趋势一致:在T0~T1和T3~T4显著下降(P<0.05),T1~T2显著上升(P<0.05),T2~T3无明显改变(P>0.05);组间比较T2、T3时刻比较,差异有统计学意义(P<0.05),T0、T1、T4时刻比较,差异无统计学意义(P>0.05);两组Ramsay评分在T0、T1、T4时刻比较,差异无统计学意义(P>0.05),T2、T3时刻比较,差异有统计学意义(P<0.05);观察组HR、MAP、SpO2、Ramsay评分比对照组更为稳定。两组Nogo-A mRNA、Nogo-A、HIF-1α、VEGF蛋白表达趋势,入室后逐渐升高,在术后3 d达到峰值,在术后1周回落,观察组在术毕和术后3 d时Nogo-A mRNA、Nogo-A、HIF-1α、VEGF表达显著低于对照组(P<0.05)。结论:右美托咪定联合瑞芬太尼、丙泊酚麻醉有利于维持神经外科手术中血流动力学平衡,麻醉和术中唤醒�
Objective:To investigate the influence of dexmedetomidine combined with remifentanil and propofol on the quality of neurosurgical anesthesia and the expression of serum Nogo-A and hypoxia inducible factor 1α(HIF-1α).Methods:A total of 100 patients who underwent neurosurgery at the First Hospital of Yulin City,Shaanxi Province from January 2015 to June 2018 were collected and randomly divided into a control group and an observation group,with 50 cases in each group.The control group was anesthetized with propofol and remifentanil,and the observation group was combined with dexmedetomidine on the basisof the control group.The clinical indicators,adverse events,intraoperative awareness,and response ability in wake-up tests of the two groups were compared.The mean arterial pressure(MAP),heart rate(HR),saturation of peripheral O2(SpO2),and score in the Ramsay sedation scale(Ramsay score)at admission(T0),30 min before wake-up(T1),immediately after wake-up(T2),5 min after wake-up(T3)and after 10 min of continued anesthesia at the end of wake-up test(T4)were compared between the two groups.The expression of serum Nogo-A mRNA,Nogo-A,HIF-1αand vascular endothelial growth factor(VEGF)at admission,after surgery,3 d after surgery and 1 week after surgery were compared between the two groups.Results:There were no statistically significant difference in anesthesia time before awakening,cis-atracurium dosage,intraoperative awareness,and tachycardia incidence between the two groups(P>0.05).The wake-up time,time to recovery of spontaneous breath,propofol dosage,remifentanil dosage as well as incidence of restlessness and choking in the observation group were significantly lower than those in the control group(P<0.05).The response satisfaction rate in the observation group was significantly higher than that in the control group(90.00%vs 74.00%,P<0.05).The trend of change in HR,MAP and SpO2 in the two groups were the same:they were significant decrease in T0-T1 and T3-T4(P<0.05),significant increase in T1-T2(P<0.05),and no signif
作者
李清军
刘峰
杨晓艳
Li Qingjun;Liu Feng;Yang Xiaoyan(Department of Anesthesiology,The First Hospital of Yulin City,Shaanxi Province,Yulin 718000,China;Department of Anesthesiology,The First People’s Hospital of Xianyang City,Shaanxi Province,Xianyang 712000,China)
出处
《广西医科大学学报》
CAS
2020年第5期922-928,共7页
Journal of Guangxi Medical University
