The Effects Of Dexmedetomidine On Sympathetic Response And Serum Tnf-a And Il-6 Level Of In Patients With Intracranial Aneurysm Undergoing Interventional Operation

Objective: To observe The effects of dexmedetomidine on sympathetic response and serum TNF-a and IL-6 level of in patients with intracranial aneurysm undergoing interventional operation,and to discuss the mechanism of the role of brain protection of dexmedetomidine.Methods: eighty cases of patients with intracranial aneurysm aged 18-66 yr,ASA?or?,scheduled for interventional operation,were randomly divided into 2 groups?n=40 each?: control group?group C?and dexmedetomidine group?group D?.In group D,dexmedetomidine 1?g/kg?initial dose?was given over more than 10 min before anaesthesia induction,followed by continuous infusion at 0.4?g·kg^-1·h^-1 until 30 min before the end of operation.In group C,the equal volume of normal saline was infused.Anesthesia induction withmidazolam 0.05mg/kg,sufentanil 0.5?g/kg,etomidate 0.3 mg/kg and rocuronium 0.6 mg/kg.After endotracheal intubation undergoing mechanical ventilation.Anesthesia induction: intravenous midazolam 0.05mg/kg,sufentanil 0.5ug/kg,etomidate 0.3mg/kg,and rocuronium 0.6 mg/kg were given,endotracheal intubation through the mouth,then fixed the endotracheal tube and connected the anesthesia machine to mechanical ventilation,punctured radial artery to monitor the artery pressure.Tidal volume 6¹0ml/kg,ventilatory frequency 11¹4 times per minute,to maintain end-tidal carbon dioxide tension?PETCO2?between 35⁴0mm Hg,the blood oxygen saturation > 95%,airway pressure<40mm Hg.Maintenance of anesthesia: fentany 0.05⁰.2?g·kg^-1·min^-1,propofol 4⁸mg·kg^-1·h^-1 were given with trace intravenous infusion pump,dose adjustment according to surgical stimulation.Maintaining the mean arterial pressure fluctuation amplitude was no more than 20% of the basis values,the bispectral index?BIS?value between 40 and 60.Patients awaked and then pulled out the endotracheal tube,then back to the ward after the surgery.The diastolic,systolic and heart rate were recorded at the time of 3 min after calm?T1?,immediately before intubation?T2?,immediately after intubation?T3?,3 min after intubation?T4?.Arterial blood samples were collected at the time of 3 min after calm?T1?,immediately before embolism?T5?,the end of operation?T6?,6h after operation?T7?and 24 h after operation?T8?to determination of serum TNF-a and IL-6 levels.Results: Hemodynamic changes of intubation compared with T1,systolic at T2 was decreased?P<0.05?,systolic and heart rate were at T3,T4 and diastolic at T3 were decreased in group C?P<0.05?.Systolic and heart rate at T2 and systolic and diastolic at T4 were decreased in group D?P< 0.05?.compared with group C,systolic,diastolic and heart rate were decreased at T3?T4 in group D?P<0.05?,volatility of systolic,diastolic and heart rate were decreased at T3?T4 in group D?P<0.05?.Serum TNF-a and IL-6 levels compared with T1,serum TNF-a and IL-6 levels were increased at T6-8 in two groups?P<0.05?.compared with group C,serum TNF-a and IL-6 levels were decreased at T6-8 in group C?P<0.05?.Conclusion: Given 1?g/kg loading dose of dexmedetomidine,followed by 0.4 ?g/kg continuous infusion,can prevent sympathetic responses to intubation of general anesthesia patients of intracranial aneurysms,and can reduce the level of serum inflammatory factors in patients after intracranial aneurysm embolization.