Effect Of Dexmedetomidine On Brain Protection In Patients Undergoing Moderate Craniocerebral Injury Surgery

Objective:To investigate the protective effect of dexmetomidine on brain injury in patients undergoing moderate craniocerebral injury surgery by observing hemodynamics,inflammatory response and brain injury markers.Methods:70 patients undergoing moderate craniocerebral injury surgery(18-60 years)were selected from April 2018 to June 2019.The ASA degrade was ?-?.Patients were randomly assigned to two groups:a group with saline(group C)and a group with dexmedetomidine(group D).There were 33 patients in group C and 32 patients in group D because of exit criteria.The patients in group D were given dexmedetomidine intravenous infusion within 10 min before anesthesia induction at a loading dose of 1?g/kg(4?g/ml).The speed was adjusted to 0.4?g/kg/h until the beginning suture scalp during the surgery.The patients in group C were given saline intravenous infusion with equivalent capacity.The anesthesia induction and maintenance protocols were the same in the two groups.Anesthesia induction:the patients were intravenous injected with midazolam,propofol,sufentanil,and rocuronium.Anesthesia maintenance:the patients were pump injected with propofol and remifentanil and intravenous injected with rocuronium as required.Patients were maintained anesthesia with propofol and remifentanil hydrochloride until scalp sutured completely.The depth of anesthesia was adjusted according to bispectral index(BIS),hemodynamics,and surgical stimulation intensity.MAP and HR were recorded at the time of 5 min before dexmedetomidine or saline pump injection(T0),the time of anesthesia induction(T1),the time of trachea cannula(T2),the time of scalp cut(T3),the time of skull removed(T4),the time of scalp suture(T5).Blood specimens were collected at T0,T5,the time of 6h after operation(Ta)and the time of 24h after operation(Tb).The concentrations of TNF-?,IL-6,S100?,and NSE were measured with the ELISA kits.The GCS scores,MAP,and HR were measured at T0,Ta,and Tb.The dosages of remifentanil and propofol during operation were recorded.The spontaneous respiration recovery time and extubation time were recorded.The adverse reactions were recorded within 24 h after operation.Results:(1)The patients'basic information(gender,age,body mass index,ASA degrade)in two groups was no significant differences(P>0.05).(2)The time of operation and bleeding in two groups were no significant differences(P>0.05).Compared with group C,the dosages of propofol and remifentanil decreased in group D(P<0.05).(3)Compared with group C,the patients' MAP decreased at T1 and T2(P<0.05),increased at T4(P<0.05)in group D.The patients' MAP in group C was no significant differences at T0 and T1(P>0.05).Compared with T1 in group C,the patients' MAP increased at T2(P<0.05),and decreased at T3,T4,and T5(P<0.05).The patients' MAP in group D was no significant differences at T0 and T1(P>0.05).Compared with T1 in group D,the patients'MAP was no significant differences(P>0.05)at T2,T3,T4,and T5.(4)Compared with group C,the patients' HR decreased at T1,T2,T3,T4,and T5 in group D(P<0.05).The patients'HR in group C was no significant differences at T0 and T1(P>0.05).Compared with T1 in group C,the patients' HR increased at T2,T3,and T4(P<0.05).Compared with T0 in group D,the patients' HR decreased at T1(P<0.05).Compared with T1 in group D,the patients' HR was no significant differences(P>0.05)at T2,T3,T4,and T5.(5)The spontaneous respiration recovery time and extubation time were no significant differences in the two groups(P>0.05).(6)Compared with T0 in group C and group D,the concentrations of TNF-?,IL-6,S100?,and NSE increased at T5,Ta,and Tb(P<0.05).Compared with group C,the concentrations of TNF-?,IL-6,S100?,and NSE decreased at T5,Ta,and Tb in group D(P<0.05).(7)Compared with group C,GCS scores increased at Ta and Tb in group D(P<0.05).The patients' MAP and HR were no significant differences in the two groups(P>0.05).(8)Compared with group C,the incidences of adverse reactions decreased(P<0.05).Conclusion:(1)Dexmedetomidine could reduce the amount of propofol and remifentanil in patients undergoing moderate craniocerebral injury surgery,and maintain hemodynamic stability.(2)Dexmedetomidine could reduce the inflammatory response in patients undergoing moderate craniocerebral injury surgery.(3)Dexmedetomidine could reduce the degree of brain injury and the incidences of adverse reactions in patients undergoing moderate craniocerebral injury surgery.