Department of Anesthesiology, The First People's Hospital of Daishan, 316200 Zhoushan, Zhejiang, China.
Department of Anesthesiology, Sahzu International Medical Center, 311215 Hangzhou, Zhejiang, China.
Actas Esp Psiquiatr. 2024 Feb;52(1):19-27.
The protective mechanism of dexmedetomidine on the brains of patients undergoing craniocerebral surgery remains unclear. The aim of this study was to examine the impact of dexmedetomidine on cognitive function, oxidative stress, and brain protection in such patients.
Fifty-four patients who underwent craniocerebral surgery at our hospital from January 2020 to June 2023 were retrospectively selected as study subjects. They were divided into two groups: the control group (n = 27) and the study group (n = 27), based on different auxiliary anesthesia protocols. Patients in the study group received dexmedetomidine before anesthesia induction, using a midline intravenous pump to assist anesthesia, while the control group received an equivalent amount of normal saline. The remaining anesthesia induction and maintenance protocols were consistent for both groups. Cognitive function was assessed using the Mini Mental State Examination (MMSE) before and 1 day after surgery for both groups. Oxidative stress indicators, including malondialdehyde (MDA), glutathione peroxidase (GSH-Px), and superoxide dismutase (SOD) levels in the serum of both groups, were measured using enzyme-linked immunosorbent assay (ELISA). Additionally, changes in postoperative brain injury indicators, namely neuron-specific enolase (NSE) and central nervous system-specific protein (S100β), were detected and compared in the serum of both groups. Concurrently, postoperative adverse reactions were recorded for both groups.
The MMSE scale scores of both groups of patients 24 hours after surgery were significantly lower than those before surgery. However, the MMSE scale scores of the study group patients were notably higher than those in the control group, with a statistically significant difference (p < 0.05). One hour after surgery, the serum levels of MDA, GSH-Px, and SOD in both groups of patients were significantly elevated compared to pre-surgery levels. Yet, the study group exhibited significantly lower levels of MDA, GSH-Px, and SOD in comparison to the control group, and these differences were statistically significant (p < 0.05). The serum levels of NSE and S100β in both groups were markedly higher than preoperative levels 24 hours after surgery. However, the study group demonstrated significantly lower levels of serum NSE and S100β compared to the control group, with a statistically significant difference (p < 0.05). The incidence of postoperative complications in the study group was 7.41% (2/27), indicating a decreasing trend compared to 18.52% (5/27) in the control group. However, this difference did not reach statistical significance (χ2 = 1.477, p = 0.224).
Dexmedetomidine-assisted anesthesia in craniocerebral surgery can effectively enhance postoperative cognitive function, mitigate oxidative stress, and facilitate overall postoperative recovery for patients. The intervention exhibits a favorable safety profile with no reported serious adverse reactions, establishing it as a relatively safe and reliable approach.
右美托咪定对行颅脑手术患者的脑保护机制尚不清楚。本研究旨在探讨右美托咪定对这类患者认知功能、氧化应激和脑保护的影响。
回顾性选择 2020 年 1 月至 2023 年 6 月在我院行颅脑手术的 54 例患者为研究对象。根据不同的辅助麻醉方案，将其分为对照组（n=27）和研究组（n=27）。研究组患者在麻醉诱导前给予右美托咪定，采用中线静脉输液泵辅助麻醉，对照组患者给予等容量生理盐水。两组其余麻醉诱导和维持方案相同。两组患者均在术前和术后 1 天采用简易精神状态检查量表（MMSE）评估认知功能。采用酶联免疫吸附试验（ELISA）检测两组患者血清丙二醛（MDA）、谷胱甘肽过氧化物酶（GSH-Px）和超氧化物歧化酶（SOD）水平，评估氧化应激指标。同时，检测并比较两组患者血清中术后脑损伤标志物神经元特异性烯醇化酶（NSE）和中枢神经系统特异性蛋白（S100β）的变化。同时记录两组患者术后不良反应。
两组患者术后 24 小时 MMSE 量表评分均明显低于术前，但研究组患者评分明显高于对照组，差异有统计学意义（p<0.05）。术后 1 小时，两组患者血清 MDA、GSH-Px 和 SOD 水平均明显高于术前，但研究组明显低于对照组，差异有统计学意义（p<0.05）。两组患者术后 24 小时血清 NSE 和 S100β水平均明显高于术前，但研究组明显低于对照组，差异有统计学意义（p<0.05）。研究组术后并发症发生率为 7.41%（2/27），呈下降趋势，对照组为 18.52%（5/27），但差异无统计学意义（χ2=1.477，p=0.224）。
右美托咪定辅助颅脑手术麻醉可有效提高术后认知功能，减轻氧化应激，促进患者整体术后恢复。该干预措施安全性良好，无严重不良反应报告，是一种相对安全可靠的方法。
