目的 探讨右美托咪定辅助硬膜外麻醉在中转剖宫产手术中的应用价值,观察不同方案的麻醉效果.方法 选取2016年1月-2019年12月在该院阴道试产失败中转剖宫产并接受右美托咪定辅助硬膜外麻醉的42例产妇为观察组,同期在该院阴道试产失败中转剖宫产并接受生理盐水辅助硬膜外麻醉的38例产妇为对照组,回顾性分析两组研究对象临床资料.比较两组产妇感觉阻滞起效时间,感觉阻滞时间及最高阻滞平面;比较两组产妇镇静评分(Ramsay评分),牵拉反应评分及新生儿娩出后1min、5min的Apgar评分;比较两组产妇麻醉前(T0)、切皮时(T1)胎儿取出时(T2)、关腹时(T3)的平均动脉压(MAP)、心率(HR)和血氧饱和度(SPO2)等血流动力学情况;记录两组产妇不良反应发生情况.结果 观察组产妇感觉阻滞起效时间短于对照组,感觉阻滞时间长于对照组,最高阻滞平面高于对照组,差异均有统计学意义(均P＜0.05).观察组产妇Ramsay评分和牵拉反应评分均高于对照组,差异均有统计学意义(均P＜0.05).两组新生儿Apgar评分比较,差异均无统计学意义(均P＞0.05).T1～T3时,观察组产妇HR、MAP水平均低于T0时,且观察组低于对照组,差异均有统计学意义(均P＜0.05).两组产妇各时点SPO2水平相近,差异均无统计学意义(均P＞0.05).两组产妇不良反应发生率比较,差异无统计学意义(P＞0.05).结论 右美托咪定辅助硬膜外麻醉在中转剖宫产手术中的应用效果较好,更利于稳定产妇术中血流动力学稳定,产妇获得的镇静效果及感觉阻滞效果更好,且不会增加不良反应,安全性较高.

Objective To evaluate the effect of dexmedetomidine on postoperative cognitive function in the patients with mild hyperbilirubinemia caused by choledocholithiasis.Methods One hundred and twenty patients of both sexes with mild hyperbilirubinemia (serum total bilirubin levels 21-170μ mol/L) caused by choledocholithiasis,aged 51-63 yr,with body mass index of 20-28 kg/m2,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,with preoperative Mini-Mental State Examination (MMSE) scores ≥ 20,scheduled for elective cholecystectomy and choledocholithotomy,were divided into 3 groups (n =40 each) using a random number table method:control group (C group) and dexmedetomindine 0.4 μg · kg-1 · h-1 group (D1 group) and dexmedetomindine 0.6 μg · kg1 · h-1 group (D2 group).After induction of anesthesia,dexmedetomidine was intravenously infused for 10 min in a loading dose of 0.5 μg/kg,followed by an infusion of 0.4 and 0.6 μg · kg-1 · h-1 until the end of operation in D1 and D2 groups,respectively.The equal volume of normal saline was given instead in group C.with preoperative scores ≥ 20,MMSE and Montreal Cognitive Assessment (MoCA) were used to assess the cognitive function at 1 day before operation (T0) and 1,3,5 and 7 days after operation (T1-4).The occurrence of cognitive dysfunction within 7 days after operation was recorded.Venous blood samples were collected at the time points mentioned above,and the plasma concentrations of β-amyloid (Aβ) 42 were determined by enzymelinked immunosorbent assay.Results Compared with group C,MoCA scores were significantly increased at T1 in group D1,and MMSE scores at T1 and MoCA scores at T1 and T2 were significantly increased,and the plasma concentrations of Aβ42 were decreased at T2-4 in group D2,and the incidence of cognitive dysfunction was significantly decreased in D1 and D2 groups (P＜0.05).Compared with group D1,MoCA scores were significantly increased at T1,and the plasma concentrations of Aβ42 were decreased at T2-4 in group D2 (P＜0.05).Conclusion Dexmedetomidine can improve postoperative cognitive function,and intravenous infusion at a rate of 0.6 μg · kg-1 · h-1 provides better efficacy for the patients with mild hyperbilirubinemia caused by choledocholithiasis.

目的 探讨右美托咪定(Dex)对蛛网膜下腔出血(SAH)大鼠早期脑损伤的影响,并探讨其作用机制.方法 将SD大鼠分为假手术组、SAH组和SAH+Dex组,SAH组和SAH+Dex组采用颈内动脉刺破法建立SAH模型,假手术组仅进行手术操作但不穿孔.术后2 h,SAH+Dex组腹腔注射25 g/kg Dex,SAH组腹腔注射等体积生理盐水,假手术组不进行药物干预.术后24 h,对存活大鼠进行神经功能评分;处死大鼠,测算脑水分含量;暴露脑组织基底池,进行SAH分级评分;取脑组织,采用免疫荧光双标法检测小神经胶质细胞及其亚型含量,ELISA法检测炎症因子IL-4、IL-13、IL-1、IL-6、TNF-α含量,Western blotting法检测血脑屏障相关蛋白Occludin、ZO-1及凋亡相关蛋白caspase-3、Bax、Bcl-2表达.结果 与假手术组比较,SAH组神经功能评分降低,脑水分含量和SAH分级评分增加;脑组织小神经胶质细胞数和M1型含量增加;脑组织IL-13含量降低,IL-1、IL-6、TNF-α含量升高;脑组织Occludin、ZO-1、Bcl-2蛋白表达降低,caspase-3、Bax蛋白表达及Bax/Bcl-2比值升高(P均<0.05).与SAH组比较,SAH+Dex组神经功能评分增加,脑水分含量降低;脑组织小神经胶质细胞数和M1型含量降低,M2型含量增加;脑组织IL-4、IL-13水平升高,IL-1、IL-6、TNF-α水平降低;脑组织Occludin、ZO-1和Bcl-2蛋白表达增加,caspase-3、Bax蛋白表达及Bax/Bcl-2降低(P均<0.05).结论 Dex对SAH后大鼠具有神经保护作用,其机制可能与修复血脑屏障、调整小神经胶质细胞的亚型、抑制促炎因子的释放、降低细胞凋亡有关.