摘要
目的探讨利多卡因联合右美托咪定对幕上肿瘤切除术患者苏醒期效果以及脑损伤的作用。方法选取2021年3月—2022年9月徐州医科大学附属医院收治的择期在静脉复合全身麻醉下行幕上肿瘤切除术患者76例。采用随机数字表法将所有患者分为对照(Con)组、利多卡因(Lido)组、右美托咪定(DEX)组和利多卡因联合右美托咪定(Lido+DEX)组。各组基础麻醉药物一致,持续输注相应药物至手术结束。比较各组患者在入室10 min(T0)、麻醉1 h(T1)、术毕拔管时(T2)、拔管3 min(T3)时的血流动力学变化及躁动、呛咳的发生情况。同时检测苏醒期神经元特异性烯醇化酶(NSE)与S-100β蛋白水平评价脑损伤情况。结果各组脑幕上肿瘤患者在T0时心率(HR)和平均动脉压(MAP)比较,差异无统计学意义(P>0.05);在T2时,与Con组比较,DEX组和Lido+DEX组HR和MAP均明显降低,Lido+DEX组MAP与Lido组比较差异有统计学意义(P<0.05)。与Con组比较,苏醒期Lido+DEX组未发生呛咳和躁动的比例明显增高,且与Lido和DEX组比较,Lido+DEX组未发生呛咳比例差异有统计学意义(P<0.05)。在T0时,各组血清NSE和S-100β水平比较差异无统计学意义(P>0.05)。在T3时,与Con组相比,DEX组和Lido+DEX组中NSE水平明显降低;Lido、DEX和Lido+DEX组中S-100β水平明显降低(P<0.05)。与Lido组比较,Lido+DEX组NSE水平明显降低(P<0.05);与DEX组比较,Lido+DEX组S-100β水平明显降低(P<0.05)。结论利多卡因联合右美托咪定输注可明显维持患者苏醒期血流动力学稳定,减少呛咳和躁动发生,进而减轻脑幕上肿瘤切除患者的脑损伤。
Objective To investigate the effect of lidocaine combined with dexmedetomidine on the recovery period and brain injury of patients undergoing supratentorial tumor resection.Methods A total of 76 patients who were scheduled for supratentorial tumor resection under combined intravenous-general anesthesia in the Affiliated Hospital of Xuzhou Medical University from March 2021 to September 2022 were selected.According to the random number table method,the patients were divided into four groups:a control(Con)group,a lidocaine(Lido)group,a dexmedetomidine(DEX)group and a lidocaine plus dexmedetomidine(Lido+DEX)group.All the patients received the same basic anesthetics,and were continuously infused with the corresponding drugs until the end of the operation.Then,the hemodynamics,agitation and coughing were measured 10 min after entering into the room(T0),at post-anesthesia 1 h(T1),at the withdrawal of the tube(T2),and 3 min after withdrawal of the tube.Meanwhile,the levels of neuron-specific enolase(NSE)and S-100βprotein were detected to evaluate the brain injury.Results There was no statistical difference in heart rate(HR)and mean arterial pressure(MAP)among the four groups(P>0.05).At T2,compared with the Con group,the DEX,and Lido+DEX groups showed significant decreases in HR and MAP.At T2,there was statistical difference in MAP between the Lido+DEX and Lido groups(P<0.05).Compared with the Con group,the Lido+DEX group had significantly higher rates of non-coughing and agitation during the recovery period,and there was statistical difference in the rate of non-coughing between the Lido+DEX group and the Lido and DEX groups(P<0.05).At T0,the levels of NSE and S-100βin each group were not statistically different(P>0.05).At T3,compared with the Con group,the levels of NSE were significantly reduced in the DEX group and Lido+DEX group;while the levels of S-100βin the Lido,DEX,and Lido+DEX groups remarkably decreased.Furthermore,compared with the Lido group,the Lido+DEX group showed statistical decreases in NSE levels(P<0.05);compared with the DEX group,the Lido+DEX group showed statistical decreases in S-100βlevels(P<0.05).Conclusions Lidocaine combined with dexmedetomidine can significantly maintain the hemodynamic stability of patients during the recovery period and reduce the occurrence of coughing and agitation,in order to attenuate the brain injury in patients with supratentorial tumor resection.
作者
周丽
张稳稳
陈秀侠
ZHOU Li;ZHANG Wenwen;CHEH Xiuxia(Department of Anesthesiology,Women′s Hospital of Nanjing Medical University,Nanjing Maternity and Child Healthcare Hospital,Nanjing,Jiangsu 210004,China;Department of Anesthesiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221004)
出处
《徐州医科大学学报》
CAS
2023年第10期714-719,共6页
Journal of Xuzhou Medical University
基金
国家自然科学基金青年基金(81701084)
江苏省神经退行性疾病重点实验室开放课题(KF202204)。
