Ge Yali, Li Qian, Nie Yuyan, Gao Ju, Luo Ke, Fang Xiangzhi, Wang Cunjing
1 Department of Anesthesiology, Northern Jiangsu People's Hospital, Yangzhou City, Jiangsu Province, China.
2 Department of Anesthesiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
J Int Med Res. 2019 Jun;47(6):2471-2482. doi: 10.1177/0300060519843738. Epub 2019 Apr 24.
Carotid endarterectomy (CEA) is efficient in preventing stroke for patients with significant carotid stenosis, but results in mild cognitive dysfunction. Dexmedetomidine is neuroprotective in stroke models. We hypothesized that dexmedetomidine may improve cognition after CEA.
Forty-nine patients scheduled for elective CEA were randomly assigned to intravenous dexmedetomidine treatment group (n = 25) and control group C (normal saline, n = 24). Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MOCA), as well as lactate, TNF-α, IL-6, and BDNF levels in blood, were assessed before, during, and after surgery.
MMSE and MOCA scores showed subtle decline in both groups at 24 hours postoperatively; this decline remained at 48 hours postoperatively in group C. Both scores were higher in group D than in group C at 48 and 72 hours postoperatively. TNF-α and IL-6 were lower from 5 minutes post-clamping through 24 hours postoperatively in group D; lactate was lower at 5 minutes post-clamping in group D. BDNF was higher from 5 minutes post-clamping through 1 hour postoperatively in both groups, and remained high in group D at 24 hours postoperatively.
Dexmedetomidine improved recovery of cognition after CEA, potentially due to reduced inflammation and enhanced BDNF expression.
颈动脉内膜切除术（CEA）对重度颈动脉狭窄患者预防中风有效，但会导致轻度认知功能障碍。右美托咪定在中风模型中具有神经保护作用。我们假设右美托咪定可能会改善CEA术后的认知功能。
49例计划行择期CEA的患者被随机分为静脉注射右美托咪定治疗组（n = 25）和对照组C（生理盐水，n = 24）。在手术前、手术期间和手术后评估简易精神状态检查表（MMSE）和蒙特利尔认知评估量表（MOCA），以及血液中的乳酸、肿瘤坏死因子-α、白细胞介素-6和脑源性神经营养因子（BDNF）水平。
两组术后24小时MMSE和MOCA评分均有轻微下降；对照组C术后48小时仍保持下降。术后48小时和72小时，治疗组D的两项评分均高于对照组C。治疗组D在夹闭后5分钟至术后24小时肿瘤坏死因子-α和白细胞介素-6水平较低；治疗组D夹闭后5分钟乳酸水平较低。两组在夹闭后5分钟至术后1小时BDNF水平均较高，治疗组D术后24小时仍保持较高水平。
右美托咪定改善了CEA术后的认知功能恢复，可能是由于炎症减轻和BDNF表达增强。
