2024 年第 4 期 第 19 卷

右美托咪定在高血压脑出血患者围手术期的应用效果及对炎症和应激反应指标的影响

The application effect of dexmedetomidine in patients with hypertensive cerebral hemorrhage during the perioperative period and its effect on inflammation and stress response indicators

作者：吕瑞达 戴科芳杜晓敏张敏张慧晶

英文作者：Lyu Ruida Dai Kefang Du Xiaomin Zhang Min Zhang Huijing

单位：河北省衡水市人民医院哈励逊国际和平医院心血管内科，衡水053000

英文单位：Department of Cardiovascular Medicine Hengshui People′s Hospital Hebei Province Harrison International Peace Hospital Hengshui 053000 China

关键词：高血压脑出血；右美托咪定；炎症；应激反应

英文关键词：Hypertensivecerebralhemorrhage;Dexmedetomidine;Inflammation;Stressresponse

• 摘要：

• 目的 探讨右美托咪定在高血压脑出血患者围手术期的应用效果及对炎症和应激反应指标的影响。方法 选择2019年10月至2020年8月河北省衡水市人民医院收治的高血压脑出血患者112例作为研究对象。依据随机数字表法将患者分为观察组和对照组，每组56例。2组均接受血肿清除手术，对照组给予常规麻醉，观察组血肿清除手术后在对照组基础上给予右美托咪定。比较2组患者术后Ramsay镇静评分、血流动力学、炎症及应激指标水平和不良反应的发生情况。结果 术后24 h，观察组Ramsay镇静评分显著低于对照组［（3.63±0.21）分比（4.02±0.25）分］，差异有统计学意义（P<0.05）。术后24 h，2组患者心率、平均动脉压均低于术前，且观察组低于对照组［（70±6）次/min比（74±6）次/min、（89±7）mmHg（1 mmHg=0.133 kPa）比（97±7）mmHg］，差异均有统计学意义（均P<0.05）。术后24 h，观察组白细胞介素6、高敏C反应蛋白、肿瘤坏死因子α、丙二醛、血管紧张素Ⅱ及肾素水平明显低于对照组，白细胞介素10、超氧化物歧化酶水平明显高于对照组，差异均有统计学意义（均P<0.05）。观察组不良反应发生率明显低于对照组［8.9%（5/56）比26.8%（15/56）］，差异有统计学意义（P<0.05）。结论 右美托咪定对高血压脑出血患者血肿清除手术后镇静镇痛效果确切，可维持血流动力学稳定，减轻机体炎症反应，降低血管紧张素Ⅱ、肾素水平，有利于减少不良事件和促进术后恢复。

• Objective To investigate the application effect of dexmedetomidine in patients with hypertensive cerebral hemorrhage during the perioperative period and its effect on inflammation and stress response indicators. Methods Totally 112 patients with hypertensive cerebral hemorrhage admitted to Hengshui People′s Hospital, Hebei Province from October 2019 to August 2020 were selected as research objects. According to the random number table method, all patients were divided into observation group and control group, with 56 cases in each group. Both groups received hematoma removal surgery. The control group was given routine anesthesia, and the observation group was given dexmedetomidine after hematoma removal surgery on the basis of the control group. The Ramsay sedation score, hemodynamics, inflammatory and stress indexes and adverse reactions after surgery were compared between the two groups. Results At 24 h after surgery, the Ramsay sedation score in the observation group was significantly lower than that in the control group［(3.63±0.21) vs (4.02±0.25)］(P<0.05). At 24 h after surgery, the heart rate and mean arterial pressure levels of both groups were lower than those before surgery, and those in the observation group were lower than those in the control group［(70±6)times/min vs (74±6)times/min, (89±7)mmHg vs (97±7)mmHg］(all P<0.05). At 24 h after surgery, the levels of interleukin-6, high-sensitivity C-reactive protein, tumor necrosis factor-α, malondialdehyde, angiotensin Ⅱ, and renin in the observation group were significantly lower than those in the control group, while the levels of interleukin-10 and superoxide dismutase were significantly higher than those in control group (all P<0.05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group［8.9%(5/56) vs 26.8%(15/56)］(P<0.05). Conclusion Dexmedetomidine has a definite sedative and analgesic effect on patients with hypertensive cerebral hemorrhage after hematoma removal surgery, which can maintain hemodynamic stability, reduce the inflammatory response of the body, reduce the levels of angiotensin Ⅱ and renin, which is beneficial to reduce adverse events and promote postoperative recovery.