| Objectives The function and metabolism of the brain relies on cerebral blood flow perfusion. In order to maintain normal brain function and brain metabolism, cerebral blood flow(CBF) must remain relatively constant.In recent years, with the development of microsurgical technique, intracranial surgery is also becoming more and more popular.Therefore, perioperative attach great importance to the protection of the brain and improve brain tissue ischemia oxygen deficit, is very important to maintain normal function of nerve cells.Dexmedetomidine is a new type of high selectivity of alpha 2agonists adrenaline, can be used as neurosurgery patients perioperative sedatives and narcotic auxiliary drug use. At present,the study found DEX can reduce brain cells outside the plasma catecholamine levels, reduce the excitatory neurotransmitter glutamate,adjust the action such as part of the nerve cell apoptosis, these all is closely related to cerebral protection of intracranial tumors.Through the monitoring of cerebral oxygen supply and demand balance not only reflect the brain tissue of oxygen uptake and utilization, but also indirectly reflects the change of cerebral blood flow and intracranial pressure. Observe dexmedetomidine in patients with intracranial surgery plasma epinephrine, norepinephrine, according to the influence of the S100 protein, to explore the effect of brain protection.Methods Thiry patients undergoing intracranial tumor surgey, aged 28~65 years old,ASA Ⅰ~Ⅱ level, were randomly divided into two groups:the dexmedetomidine group(group D) and the control group(group C), 15 cases each group. All of the patients are patients undergoing elective intracranial meningioma resection for the first time, no obvious intracranial pressure, preoperative without coronary heart disease, diabetes,kidney disease and other complications.1 Anesthesia methods: Preoperative conventional ban drink, fasting 8 ~ 12 h, into the operating room in the first two group patients were intramuscular injection atropine 0.5mg, anesthesia downlink radial artery and the internal jugular vein of tumor saide puncture tube and retrograde catheter to the ministry of internal jugular vein ball. Patients in group D, dexmedetomidine 1.0μg.kg-1were injected within 15 minutes before anesthesia induction, and continuous intravenous injection0.5μg· kg-1·h-1. Patients in group C was injected equal volume of physiological saline.Other narcotic drugs and dosage were consistent with the control group. Two groups of patients were using midazolam-propofol-benzene sulfonic acid atracurium-line fentanyl induction of general anesthesia, general anesthesia to maintain the red fentanyl propofol-shun benzene sulfonic acid atracurium compound vein anesthesia. Intraoperative input liquid to liquid ringer’s lactate solution and hydroxyethyl starch(130/0.4) and sodium chloride injection. 2 Specimen: Blood samples were collected before general anesthesia induced by intubation immediate(T0), began surgery(T1), open dural immediately(T2),end of surgery(T3), 1 h after of surgery(T4) five time synchronization acquisition of internal jugular vein ball and radial artery blood gas analysis, respectively. and get the blood specimen 5 ml to vacuum tubes. 3 Detection: Using ELISA method to detect venous blood epinephrine, norepinephrine and brain damage markers-S100 protein.4Statistical analysis: Using SPSS17.0 statistical analysis software, all data with the mean and standard deviation( sx±), the measurement data of repeated measurement anova statistical processing, P<0.05 for the difference was statistically significant.Results 1 There were no significant differences by age,body weight,operation time,anesthesia time and remifentanil infusion amount between two groups of patients(P >0.05). 2 Compared with the T0, two groups of patients with internal jugular vein ball of blood oxygen saturation(Sjv O2), internal jugular venous blood oxygen content(Cjv O2) in T3 and T4 was significantly increased(P<0.05), each point in time between the two way Sjv O2 and Cjv O2 there was no significant difference(P>0.05). Compared with the T0,Oxygen levels of patients with arteriovenous difference(Ca- jv O2) and cerebral oxygen uptake rate(CERO2) at T1-T4 in the two groups was significantly lower(P<0.05), there were no significant difference between the two group(P > 0.05). 3 the group C were compared with each time point of epinephrine and norepinephrine levels were elevated(P< 0.05), group D patients epinephrine and norepinephrine levels were lower in T2-T3 time points(P < 0.05);Comparison between two groups, group D epinephrine and norepinephrine levels at T1-T4 time point was lower than those of group C(P<0.05). 4According to the comparison of two groups of patients with plasma S100βprotein at T1-T4 time points were significantly increased(P<0.05);Comparison between two groups,S100 protein of group D at T1-T4, were significantly lower than that of group C(P<0.05).Conclusions 1 Application in patients with intracranial tumor surgery dexmedetomidine,by reducing the surgical patients plasma concentration of epinephrine, norepinephrine and S100 protein concentration can have certain nerve protective effect. 2 The effect of dexmedetomidine in improving patient of cerebral oxygen supply and demand balance is not obvious, has yet to be further studies. |
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