右美托咪定对新生儿肠闭锁术后苏醒质量及血清NSE、S100β蛋白水平的影响

王龙; 张勇

doi:10.13898/j.cnki.issn.1000-2200.2020.01.009

右美托咪定对新生儿肠闭锁术后苏醒质量及血清NSE、S100β蛋白水平的影响

王龙,
张勇

Effect of dexmedetomidine on recovery quality and serum NSE and S100β protein levels in patients undergoing neonatal intestinal atresia surgery

摘要

摘要:
目的分析右美托咪定对新生儿肠闭锁术后苏醒质量及血清神经元特异性烯醇化酶（NSE）、S100β蛋白水平的影响。
方法选取60例行新生儿肠闭锁术患儿为研究对象，依据随机数字表法分为观察组（n=30）与对照组（n=30）。2组术中均予以瑞芬太尼持续静脉泵入和七氟醚吸入维持麻醉，观察组在气管插管后采取右美托咪定持续静脉泵入，对照组以同样方法持续泵入等量0.9%氯化钠溶液。比较2组麻醉前、气管插管后5 min、切皮时、术毕拔管时血流动力学指标心率（HR）、舒张压（DBP）、收缩压（SBP）水平和脑电双频指数（BIS值），术前、术后拔管后3 min、15 min、30 min Ramsay镇静评分，术前、术后6 h、1 d、3 d血清NSE、S100β蛋白水平，及2组不良反应发生率。
结果观察组气管插管后5 min、切皮时、术毕拔管时HR与DBP、SBP水平均低于对照组（P < 0.05~P < 0.01）。2组气管插管后5 min、切皮时、术毕拔管时BIS值均低于麻醉前（P < 0.05），且观察组明显低于对照组（P < 0.01）。2组术后拔管后3 min、15 min、30 min Ramsay评分均高于术前（P < 0.05），且观察组明显高于对照组（P < 0.01）。2组术后6 h、1 d、3 d血清NSE、S100β蛋白水平均高于术前（P < 0.05），但观察组低于对照组（P < 0.05~P < 0.01）。观察组不良反应总发生率为10.00%，低于对照组的33.33%（P < 0.05）。
结论新生儿肠闭锁患儿手术麻醉中加用右美托咪定可改善患儿BIS值，提高镇静效果，稳定术中血流动力学状况，提升术后苏醒质量，减轻对脑神经功能的损伤，减少不良反应发生。

Abstract:
ObjectiveTo analyze the effect of dexmedetomidine on the recovery quality and serum neuron-specific enolase (NSE) and S100β protein levels in patients undergoing neonatal intestinal atresia surgery.
MethodsSixty neonates with intestinal atresia surgery were selected and divided into observation group (n=30) and control group (n=30) according to the random number table method.During the operation, both groups received continuous intravenous infusion of remifentanil and sevoflurane inhalation to maintain anesthesia.After intubation, the observation group received continuous intravenous infusion of dexmedetomidine, and the control group received the same amount of 0.9% sodium chloride solution in the same way.The hemodynamic parametersheart rate (HR), diastolic pressure (DBP), systolic pressure (SBP) and bispectral index (BIS) were compared before anesthesia, 5 min after tracheal intubation, time of incision and extubation.The Ramsay sedation score of preoperation, 3 min, 15 min and 30 min after extubation, the serum level of NSE and S100β protein at preoperation, 6 h, 1 d and 3 d after operation, and the incidence rate of adverse reactions were compared in two groups.
ResultsThe levels of HR, DBP and SBP before anesthesia, 5 min after tracheal intubation, time of incision and extubation in observation group were lower than those in control group (P < 0.05 to P < 0.01).The BIS value at 5 min after tracheal intubation, time of incision and extubation in two groups was lower than that of before anesthesia, and which in observation group was significantly lower than that of control group (P < 0.01).The Ramsay score at 3 min, 15 min and 30 min after extubation in two groups was higher than that of before operation (P < 0.05), and which in observation group was significantly higher than that in control group (P < 0.01).The serum level of NSE and S100β protein at 6 h, 1 d and 3 d after operation in two groups was higher than that of before operation (P < 0.05), and which in observation group was lower than that in control group (P < 0.05 to P < 0.01).The total incidence rate of adverse reactions in observation group (10.00%) was lower than that in control group (33.33%) (P < 0.05).
ConclusionsThe application of dexmedetomidine in anesthesia for neonatal intestinal atresia surgery can improve the BIS value, increase the sedative effect, stabilize the hemodynamics during surgery, improve the quality of postoperative recovery, alleviate the damage to the brain nerve function, and reduce the incidence of adverse reactions.

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