网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
右美托咪定对重度子痫前期患者的脑保护及安全性研究
作者:刘月1  袁林芳1  吴卞梁1  黄义洲1  赵文静2 
单位:1. 徐州医科大学, 江苏 徐州 221000;
2. 徐州医科大学附属医院 重症医学科, 江苏 徐州 221000
关键词:右美托咪定 子痫前期 S100β蛋白 神经元特异性烯醇化酶 
分类号:R614.4
出版年·卷·期(页码):2019·47·第七期(787-791)
摘要:

目的:评价右美托咪定对重度子痫前期患者的脑保护作用及其安全性。方法:以60例重度子痫前期腰硬联合麻醉患者为研究对象,采用随机数字表法将患者分为右美托咪定组和对照组,每组30例,右美托咪定组胎儿娩出后10 min内于产妇静脉输注右美托咪定0.5 μg·kg-1,随后以0.5 μg·kg-1·h-1速率输注至术毕;对照组给予等容量生理盐水。于麻醉前(T1)、术毕(T2)、术后6 h(T3)、术后12 h(T4)及术后24 h(T5)检测两组患者血清中星形胶质细胞S100蛋白β亚型(S100β)蛋白及神经元特异性烯醇化酶(NSE)浓度,监测各时间点血流动力学及并发症发生情况,术前1 d,术后1、3 d进行简易智能精神状态量表(MMSE)评分。结果:与对照组比较,T3、T4、T5时右美托咪定组S100β蛋白浓度明显降低(P<0.05);T4、T5时右美托咪定组NSE浓度明显降低(P<0.05)。右美托咪定组术后头晕、视物模糊的持续时间较对照组明显缩短(均P<0.05),低血压发生率及术后降压药物使用率较对照组明显降低(均P<0.05);两组患者心动过缓、术后头痛持续时间、MMSE评分以及住院天数比较,差异均无统计学意义(均P>0.05)。结论:胎儿娩出后于产妇静脉输注右美托咪定可降低重度子痫前期患者血清S100β蛋白、NSE的浓度,减少围术期血压波动,降低并发症发生率,具有一定的脑保护作用。

Objective:To evaluate the neuroprotection and its safety of dexmedetomidine in patients with severe preeclampsia. Methods:Sixty patients with severe preelampsia scheduled for elective cesarean section under combined spinal-epidural analgesia were randomly divided intothe dexmedetomidine group and the control group, 30 cases each group. The dexmedetomidine group received a loading dose of dexmedetomidine 0.5 μg·kg-1 at 10 min after delivery of the fetus, followed by infusion at a rate of 0.5 μg·kg-1·h-1 until the end of operation, while the control group were treated with equivalent normal saline. The levels of serum S100β and NSE of the patieuts in the two groups were recorded before the anesthesia(T1), at the completion of operation(T2), 6 h after operation(T3), 12 h after operation(T4) and 24 h after operation(T5),repectively.At the same time, complications and hemodynamic responses were detected. The cognitive function was assessed at 1 d before operation and 1,3 dafter operation by mini-mental state examination(MMSE),repectively. Results:Compared with the control group,the levelof S100β in the dexmedetomidine group at T3, T4,T5 time points were decreased (P<0.05). The levelof NSE in the dexmedetomidine group at T4,T5 time points were lower than those of the control group(P<0.05). Compared with the control group, the lasting time of dizziness, blurred vision of the dexmedetomidine group were significantly shorter(P<0.05) and the occurrence of hypotension and the use of anti-hypertensive drugs were decreased(P<0.05).There were no significant differences in bradycardia, duration of postoperative headache, MMSE score and postoperative hospital stay(P>0.05). Conclusion:Intravenous infusion of dexmedetomidine after delivery of the fetus can reduce serum S100β protein and NSE levels in patients with severe preeclampsia, reduce perioperative blood pressure fluctuations and the incidence of complications. Dexmedetomidine can provide neuroprotection.

参考文献:

[1] 张秀海,尔丽绵.腰硬联合麻醉在重度子痫前期孕妇行剖宫产术的安全应用分析[J].中国临床医生杂志,2015, 43(9):69-71.
[2] EDWARDS M M,ROBINSON S R.TNF alpha affects the expression of GFAP and S100B:implications for Alzheimer's disease[J].J Neural Transm (Vienna),2006, 113(11):1709-1715.
[3] GRADISEK P,OSREDKAR J,KORSIC M,et al.Multiple indicators model of long-term mortality in traumatic brain injury[J].Brain Inj,2012, 26(12):1472-1481.
[4] CHABOK S Y,MOGHADAM A D,SANEEI Z,et al.Neuron-specific enolase and S100BB as outcome predictors in severe diffuse axonal injury[J].J Trauma Acute Care Surg,2012,72(6):1654-1657.
[5] FISHER N,SARAF S,EGBERT N,et al.Clinical correlates of posterior reversible encephalopathy syndrome in pregnancy[J].J Clin Hypertens (Greenwich),2016,18(6):522-527.
[6] FIELDS J A,GAROVIC V D,MIELKE M M, et al.Preeclampsia and cognitive impairment later in life[J].Am J Obstet Gynecol,2017,217(1):74.
[7] HWANG L,CHOI I Y, KIM S E,et al.Dexmedetomidine ameliorates intracerebral hemorrhage-induced memory impairment by inhibiting apoptosis and enhancing brain-derived neurotrophic factor expression in the rat hippocampus[J].Int J Mol Med,2013,31(5):1047-1056.
[8] WANG L,LIU H,ZHANG L,et al.Neuroprotection of dexmedetomidine against cerebral ischemia-reperfusion injury in rats:involved in inhibition of NF-κB and inflammation response[J].Biomol Ther (Seoul),2017,25(4):383-389.
[9] LAAKSONEN L,KALLIOINEN M,LÅNGSJÖ J,et al.Comparative effects of dexmedetomidine, propofol,sevoflurane,and S-ketamine on regional cerebral glucose metabolism in humans:a positron emission tomography study[J].Br J Anaesth,2018,121(1):281-290.
[10] SNAPIR A,POSTI J,KENTALA E,et al.Effects of low and high plasma concentrations of dexmedetomidine on myocardial perfusion and cardiac function in healthy male subjects[J].Anesthesiology,2006,105(5):902-910.
[11] ZHANG J,ZHOU H,SHENG K,et al.Foetal responses to dexmedetomidine in parturients undergoing caesarean section:a systematic review and meta-analysis[J].J Int Med Res,2017,45(5):1613-1625.
[12] OLUTOYE O A,BAKER B W,BELFORT M A.Food and drug administration warning on anesthesia and brain development:implications for obstetric and fetal surgery[J].Am J Obstet Gynecol,2018,218(1):98-102.
[13] NAKANISHI R,YOSHIMURA M,SUNO M,et al.Detection of dexmedetomidine in human breast milk using liquid chromatography-tandem mass spectrometry:Application to a study of drug safety in breastfeeding after cesarean section[J].J Chromatogr B Analyt Technol Biomed Life Sci, 2017, 1040:208-213.
[14] KAMIBAYASHI T,MAZE M.Clinical uses of alpha2·adrenergic agonists[J].Anesthesiology,2000,93(5):1345-1349.
[15] 王文凯,郭文斌,叶露.右美托咪定用于重度子痫前期患者剖宫产术中镇静的适宜剂量探讨[J].广东医学,2016, 37(7):1064-1067.
[16] 葛维鹏,张海山,杜梅青.盐酸右美托咪定用于预防剖宫产患者椎管内麻醉期间寒战反应的临床研究[J].第三军医大学学报,2012,34(21):2226-2228.

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 729933 位访问者


 ©《现代医学》编辑部
联系电话:025-83272481;83272479
电子邮件: xdyx@pub.seu.edu.cn

苏ICP备09058541