Effect of Dexmedetomidine Combined with Nalbuphine in Meningioma Surgery on Postoperative Cognitive Function
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摘要:
目的 探讨右美托咪定（dexmedetomidine，Dex）联合纳布啡在脑膜瘤手术中应用对患者炎症及术后认知功能的影响。 方法 选取2018年7月至2019年3月昆明医科大学第一附属医院行择期脑膜瘤切除术治疗的符合纳入标准的患者60例，随机分为Dex联合纳布啡组（DN组，n = 30）和Dex组（D组，n = 30）。DN组在切皮前5 min静脉注射盐酸纳布啡0.2 mg/kg，诱导前30 min予Dex1 µg/kg泵注10 min后改为0.5 µg/（kg·h），持续泵注至缝合硬脑膜前。D组相同方案给Dex。其余麻醉方案相同。 结果 DN组拔管后HR、MAP均较D组低（P < 0.05），DN组住院时间明显缩短（P < 0.05）。DN组在相同时刻IL-6、IL-10、TNF-α浓度较D组较低；同组术前比较，DN组IL-6、IL-10、TNF-α浓度升高较D组小。DN组术后6 h、24 h MMSE评分明显较D组高（P < 0.05）；与术前相比，DN组6 h MMSE评分明显较低（P < 0.05），D组6 h、24 h简易精神量表（MMSE）评分明显较低（P < 0.05）。 结论 Dex联合纳布啡对脑膜瘤切除术患者能更好的维持血流动力学指标，减轻患者炎症反应，对患者术后认知功能影响更小，缩短住院时间。 Abstract:Objective To investigate the effect of dexmedetomidine （Dex）combined with nalbuphine in meningioma surgery on inflammation and postoperative cognitive function. Methods From July 2018 to March 2019, 60 patients who underwent elective meningioma resection in the First Affiliated Hospital of Kunming Medical University and met the inclusion criteria were randomly divided into Dex combined with nalbuphine group （DN group, n = 30） and Dex group （D group, n = 30）. In the DN group, nalbuphine hydrochloride 0.2 mg/kg was injected intravenously 5 minutes before the skin incision, and Dex was injected with a pump of 1 μg/kg 30 minutes before induction, and then changed to 0.5 μg（kg·h）, and the pump was continued until meninges are sutured. Give Dex the same plan for Group D. The rest of the anesthesia scheme is same. Results After extubation, the HR and MAP in the DN group were lower than those in the D group （P < 0.05）, and the hospital stay in the DN group was significantly shorter （P < 0.05）. At the same time, the concentrations of IL-6, IL-10, and TNF-α in the DN group were lower than those in the D group; compared with the same group, the IL-6, IL-10, and TNF-α concentrations in the DN group increased less than that in the D groupbefore the operation. The 6 h and 24 h MMSE scores in the DN group were significantly higher than those in the D group （P < 0.05）; compared with preoperatively, the 6 h MMSE score in the DN group was significantly lower （P < 0.05）, and the 6 h and 24 h simple mental scale in the D group （MMSE） score was significantly lower （P < 0.05）. Conclusions Dex combined with nalbuphine can better maintain hemodynamic indexes for patients undergoing meningioma resection, reduce the inflammatory response of the patients, have a smaller impact on the postoperative cognitive function of the patients, and shorten the hospital stay. -
Key words:
- Dexmedetomidine /
- Nalbuphine /
- Meningioma surgery /
- Cognitive function
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表 1 两组术中HR、MAP和住院时间比较（
$\bar x \pm s$ ）Table 1. Comparison of intraoperative HR，MAP and hospitalization time between the two groups （
$\bar x \pm s$ ）组别 观察指标 术前 插管时 切皮时 拔管时 DN组 HR （次/min） 82.23 ± 4.85 77.03 ± 7.99# 77.73 ± 7.58# 81.03 ± 5.91* MAP （mmHg） 82.4 ± 4.35 74.77 ± 3.98# 77.70 ± 3.46# 82.50 ± 4.54* D组 HR （次/min） 82.43 ± 4.57 78.97 ± 6.81 78.83 ± 7.95# 87.23 ± 7.66# MAP （mmHg） 81.83 ± 4.28 74.93 ± 4.71# 77.93 ± 4.43# 85.30 ± 5.23# 与D组比较，*P < 0.05；与同组术前比较，#P < 0.05； 
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表 2 两组相同时间点炎症因子水平比较[（
$ {\bar{{x}}} \pm s$ ），pg/mL]Table 2. Comparison of inflammatory factor levels between the two groups at the same time point [（
$ {\bar{{x}}} \pm s$ ），pg/mL]组别 术前 2 h 6 h 24 h IL-6 IL-10 TNF-α IL-6 IL-10 TNF-α IL-6 IL-10 TNF-α IL-6 IL-10 TNF-α DN组 1.85±0.28 1.74±0.16 0.40±0.20 10.04±1.84*# 24.12±1.41*# 0.16±0.11*# 25.76±1.25*# 2.55±0.85*# 0.27±0.07*# 22.30±5.48*# 2.43±0.36*# 0.39±0.09* D组 1.94±0.38 1.75±0.15 0.38±0.17 18.26±2.34# 38.01±1.97# 0.60±0.08# 35.72±6.10# 11.59±1.34# 0.71±0.12# 49.58±5.51# 5.41±0.34# 0.79±0.11# 与D组比较，*P < 0.05；与同组术前比较，#P < 0.05。
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表 3 两组术后认知功能MMSE评分比较[（
${\bar{{x}}}\pm s$ ），分]Table 3. Comparison of MMSE scores of postoperative cognitive function between the two groups [（
${\bar{{x}}}\pm s$ ），scores]组别 术前 术后6 h 术后24 h 术后3 d 术后6 d DN组 27.37 ± 1.73 25.93 ± 2.18*# 26.33 ± 2.37* 26.77 ± 1.52 26.97 ± 1.71 D组 26.5 ± 1.93 24.80 ± 1.67# 25.10 ± 1.81# 27.33 ± 2.09 27.10 ± 1.79 与D组比较，*P < 0.05；与同组术前比较，#P < 0.05。
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