Neuroprotective Effects Of Dexmedetomidine Combined With Goal-directed Fluid Therapy In Patients With Clipping Of Intracranial Aneurysm Surgery

Objective:To observe the changes of cerebral oxygen metabolic parameters,such as hemodynamic parameters,jugular venous bulb oxygen saturation?SjvO₂?,the arterial to jugular bulb venous oxygen content difference?Da-jvO₂?and cerebral extraction rate of oxygen?CERO₂?at different time points during the peri operation period,and to detect the changes of neurological injury markers,such as S100?protein and NSE content.To evaluate the protective effect of dexmedetomidine combined with goal-directed fluid therapy on the brain of patients with clipping of intracranial aneurysms during the peri operation period.Methods:Eighty patients with clipping of intracranial aneurysms were divided into four groups by simple random sampling method:control group?group C?,dexmedetomidine group?group D?,goal-directed fluid therapy group?group G?,dexmedetomidine combined goal-directed fluid therapy group?group DG?,20 in each group.All patients underwent total intravenous anesthesia.In group D and DG,dexmedetomidine?1?g/kg?was pumped for 10 minutes before induction of anesthesia,and then 0.5?g/?kg·h?was pumped to the end of operation;In group C and G,The same amount of 0.9%normal saline was pumped.Group C and group D:volume management was performed with classical infusion scheme;Group G and DG:fluid replacement was guided by FloTrac/Vigileo monitoring SVV.HR and MAP of the four groups were monitored immediately after anesthesia induction?T₀?,dural opening?T₁?,immediately after clipping of intracranial aneurysms?T₂?,operation completion?T₃?,and 12 hours after operation?T₄?.Blood gas analysis was carried out by collecting blood from jugular bulb and radial artery.Internal jugular venous bulb oxygen saturation and arterial oxygen saturation?SjvO₂,SaO₂?,hemoglobin?Hb?,Internal Jugular venous bulb oxygen partial pressure and arterial oxygen partial pressure?PjvO₂,PaO₂?and Lactate value in bulb of internal jugular vein?jvLac?were recorded at each time point.the arterial to jugular bulb venous oxygen content difference?Da-jvO₂?,cerebral extraction rate of oxygen?CERO₂?were calculated.The concentration of S100?protein and NSE in neurochemical indicators was detected by ELISA.The volume of blood transfusion or fluid infusion,blood loss,urine volume,hospitalization days and the use of vasoactive drugs were recorded in the four groups.Cognitive function was assessed with Mini mental State Examination?MMSE?on the 1st day before operation and the 3rd day after operation.Quality of life was assessed with glasgow outcome score?GOS?before discharge.Result:1.General data comparison:There was no significant difference in gender,age,BMI,ASA classification,duration of anesthesia and educational level among the four groups?P>0.05?.2.Comparison of Intraoperative Intake:?1?Compared with group C?3713±131?,group G?3092±334?significantly decreased,group DG?2888±240?significantly decreased;?2?Compared with group D?3631±199?,group G?3092±334?significantly decreased,group DG?2888±240?significantly decreased;?3?compared with group G?3092±334?,group DG?2888±240?significantly decreased.The difference was significant?P<0.05?.3.Comparison of intraoperative output:?1?Compared with group C?1791±235?,group G?1519±398?significantly decreased and group DG?1311±77?significantly decreased;?2?Compared with group D?1781±244?,group G?1519±398?significantly decreased and group DG?1311±77?significantly decreased;?3?Compared with group G?1519±398?,group DG?1311±77?significantly decreased.The difference was significant?P<0.05?.4.HR comparison:?1?Compared with group C,heart rate of group D and group DG decreased significantly at T₁^T₄.?2?Compared with group G,heart rate in group D decreased significantly at T₁,T₂ and T₄,while heart rate in group DG decreased significantly at T₁^T₄.?3?Compared with group D,the heart rate of group DG increased significantly at T₄.The difference was significant?P<0.05?.5.MAP comparison:?1?Compared with group C,MAP decreased significantly in group D and group DG at T₁^T₃.?2?Compared with group G,MAP decreased significantly in group D and group DG at T₁^T₃.The difference was significant?P<0.05?.6.SjvO₂ comparison:?1?Compared with group C,SjvO₂ increased significantly in group D and group G at T₂ and T₃ points during operation,and SjvO₂ increased significantly in group DG at T₂^T₄ points.?2?Compared with group D and group G,SjvO₂ increased significantly in group DG at T₄ points,with statistical significance?P<0.05?.7.Da-jvO₂ Comparison:?1?Compared with group C,Da-jvO₂ in group D and group G decreased significantly at T₂ and T₃,while Da-jvO₂ in group DG decreased significantly at T₂^T₄.?2?Compared with group D and group G,Da-jvO₂ in group DG decreased significantly at T₄,with statistical significance?P<0.05?.8.CERO₂ comparison:?1?Compared with group C,CERO₂ decreased significantly in group D and group G at T₂ and T₃,while CERO₂ decreased significantly in group DG at T₂^T₄.?2?Compared with group D and group G,CERO₂ decreased significantly in group DG at T₄?P<0.05?.9.jvLac comparison:There was no significant difference in intergroup comparison of jvLac between the four groups?P>0.05?.For intergroup comparison in DG group,jvLac was significantly lower at T₃ than at T₂?P<0.05?.10.The comparison of S100?protein:?1?Compared with group C,the S100?protein decreased significantly in group D at T₃ and T₄,the S100?protein decreased significantly in group G at T₄,and the S100?protein decreased significantly in group DG at T₂^T₄.?2?Compared with group G,S100?protein decreased significantly in group D at T₃ and S100?protein decreased significantly in group DG at T₂^T₄.?3?Compared with group D,S100?protein decreased significantly in group DG at T2.The difference was significant?P<0.05?.11.NSE comparison:?1?Compared with group C,group D significantly decreased at T₂^T₄,group G significantly decreased at T₃^T₄,and group DG significantly decreased at T₁^T₄.?2?Compared with group G,DG group decreased significantly at T₁^T₄.?3?Compared with group D,DG group decreased significantly at T₁,T₃ and T₄.The difference was significant?P<0.05?.12.Comparison of MMSE scores:?1?Compared with group C,the MMSE scores of group D,group G and group DG increased significantly on the 3rd day after operation.?2?Compared with group D,the MMSE score of group DG increased significantly on the 3rd day after operation.?3?The MMSE scores of group C,group D and group G were significantly lower on the 3rd day after operation than on the 1st day before operation.The difference was significant?P<0.05?.13.Comparison of GOS score,hospitalization time and vasoactive drug use:There was no significant difference in GOS score,hospitalization time and vasoactive drug use among the four groups?P>0.05?.Conclusion:In patients with clipping of intracranial aneurysm surgery,dexmedeto-midine infusion combined with goal-directed fluid therapy can provide better brain protection.