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目的探讨乌司他汀与右美托咪定对幕上肿瘤切除术患者脑氧供需及能量代谢的影响。方法选取2014年9月至2016年9月间大连大学附属中山医院收治的70例幕上肿瘤切除术患者,采用随机数字表法分为乌司他汀组(采用乌司他汀进行麻醉)与右美托咪定组(采用右美托咪定进行麻醉),每组35例,对比两组患者不同时间点的脑氧供需及能量代谢指标。结果乌司他汀组患者麻醉诱导后的各时间点与诱导前(T1)相比,脑氧供需指标动脉血氧含量(CaO_2)、颈静脉球部血氧饱和度(SjvO_2)、颈内静脉血氧含量(CjvO_2)、动-静脉血氧含量差(Ca-JvO_2)和脑氧摄取率(CER02)差异均有统计学意义(均P<0.05)。右美托咪定组患者麻醉诱导后的各时间点与诱导前(T1)相比,CaO_2、SjvO_2、CjvO_2、Ca-JvO_2和CER02差异均无统计学意义(均P>0.05)。乌司他汀组患者麻醉诱导后的各时间点与诱导前(T1)相比,能量代谢指标为葡萄糖摄取率(Glu ER)、脑乳酸生成率(Lac PR)和脑乳酸氧指数(LOI)差异均有统计学意义(均P<0.05)。右美托咪定组患者麻醉诱导后的各时间点与诱导前(T1)相比,Glu ER、Lac PR和LOI差异均无统计学意义(均P>0.05)。结论与乌司他汀相比,在幕上肿瘤切除术中给予右美托咪定,有利于患者的脑氧供需及能量代谢,发挥脑保护作用。
Objective To investigate the effects of ulinastatin and dexmedetomidine on cerebral oxygen supply and metabolism and energy metabolism in supratentorial tumor resection. Methods Seventy patients with supratentorial tumor who underwent surgery at Zhongshan Hospital Affiliated to Dalian University from September 2014 to September 2016 were randomly divided into ulinastatin group (using ulinastatin for anesthesia) and dexmedetomidine Tropimang group (using dexmedetomidine for anesthesia), 35 cases in each group, comparing the two groups of patients at different time points of cerebral oxygen supply and demand and energy metabolism indicators. Results Compared with pretreatment (T1), the cerebral oxygen supply and demand indexes (CaO_2, SjvO_2, jugular venous blood The differences of oxygen content (CjvO_2), arterial-venous oxygen content (Ca-JvO 2) and cerebral oxygen uptake rate (CER02) were statistically significant (all P <0.05). There was no significant difference in CaO_2, SjvO_2, CjvO_2, Ca-JvO_2 and CER02 between the two groups after induction of anesthesia (P> 0.05) at all time points after dexmedetomidine induction. The indexes of energy metabolism were glucose uptake rate (Glu ER), lactate production rate (Lac PR) and cerebral lactate oxygen index (LOI) in the ulinastatin group at various time points after induction of anesthesia compared with that before induction (T1) All were statistically significant (P <0.05). There were no significant differences in Glu ER, Lac PR and LOI between the two groups (P> 0.05) at all time points after induction of anesthesia in patients with dexmedetomidine. Conclusions Compared with ulinastatin, dexmedetomidine is given during supratentorial tumor resection, which is beneficial to brain oxygen supply and demand, energy metabolism and brain protection.