不同剂量右美托咪定对脑外科手术全身麻醉患者术后认知功能及TGF-β/Smad通路的影响

Effects of different doses of dexmedetomidine on postoperative cognitive function and TGF-β/Smad pathway in patients undergoing brain surgery under general anesthesia

摘要:

目的 探讨不同剂量右美托咪定对脑外科手术全身麻醉患者术后认知功能及转化生长因子-β（TGF-β）/Smad通路的影响。方法 选取2020年1月—2023年1月宁夏医科大学总医院收治的114例行血肿清除术患者为研究对象，分为A、B、C组，每组38例，分别以0.2、0.4、0.8 μg/（kg·h）泵注右美托咪定。比较3组患者围手术期指标，血流动力学，镇痛、镇静及认知功能评分，TGF-β₁和Smad2水平，以及不良反应发生情况。结果 C组丙泊酚用量低于A、B组，B组丙泊酚用量低于A组（P <0.05）。给药后10 min（T₁），C组血氧饱和度（SpO₂）低于A、B组，B、C组收缩压（SBP）低于A组（P <0.05）；拔管时（T₂），B、C组心率（HR）、SBP低于A组，C组SpO₂低于A、B组（P <0.05）。拔管后15 min（T₃），B、C组视觉模拟评分（VAS）低于A组，Ramsay评分高于A组（P <0.05）；拔管后30 min（T₄），C组VAS评分低于A组，Ramsay评分高于A组（P <0.05）；术后1 d和术后3 d，B、C组蒙特利尔认知评估量表（MoCA）评分均高于A组（P <0.05）。术后7 d，B、C组TGF-β₁、Smad2水平低于A组，C组TGF-β₁、Smad2水平低于B组（P <0.05）。C组恶心呕吐发生率低于A组（P <0.05）。结论 脑外科术中以0.8 μg/（kg·h）速率静脉泵注右美托咪定可明显减少术中丙泊酚用量及不良反应，维持血流动力学稳定，具有较好的镇痛、镇静作用，且能够改善患者术后认知功能，可能与抑制TGF-β/Smad通路表达有关。

Abstract:

Objective To investigate the effects of different doses of dexmedetomidine on postoperative cognitive function and the transforming growth factor-β (TGF-β)/Smad pathway in patients undergoing neurosurgical procedures.Methods A total of 114 patients undergoing hematoma evacuation surgery from January 2020 to January 2023 at Ningxia Medical University General Hospital were divided into three groups (A, B, and C), with 38 patients in each group. Dexmedetomidine was administered at rates of 0.2, 0.4, and 0.8 μg/(kg·h) in groups A, B, and C, respectively. Perioperative indicators, hemodynamics, analgesic and sedative scores, TGF-β₁ and Smad2 levels, and adverse reactions were compared among the three groups.Results The dose of propofol in group C was lower than in groups A and B, and group B had a lower propofol dose than group A (P < 0.05). At 10 minutes after drug administration (T₁), group C had lower oxygen saturation (SpO₂) than groups A and B, and groups B and C had lower systolic blood pressure (SBP) than group A (P < 0.05). At extubation (T₂), heart rate (HR) and SBP in groups B and C were lower than in group A, and SpO₂ in group C was lower than in groups A and B (P < 0.05). At 15 minutes after extubation (T₃), visual analog scale (VAS) scores in groups B and C were lower than in group A, and Ramsay scores were higher than in group A (P < 0.05). At 30 minutes after extubation (T₄), VAS scores in group C were lower than in group A, and Ramsay scores were higher than in group A (P < 0.05). On postoperative day 1 and day 3, Montreal Cognitive Assessment (MoCA) scores in groups B and C were higher than in group A (P < 0.05). On postoperative day 7, TGF-β₁ and Smad2 levels in groups B and C were lower than in group A, and TGF-β₁ and Smad2 levels in group C were lower than in group B (P < 0.05). The incidence of nausea and vomiting in group C was lower than in group A (P < 0.05).Conclusion Intravenous administration of dexmedetomidine at a rate of 0.8 μg/(kg·h) during neurosurgical procedures significantly reduces intraoperative propofol consumption and adverse reactions, maintains stable hemodynamics, provides effective analgesia and sedation, and improves postoperative cognitive function. These effects may be associated with the inhibition of the TGF-β/Smad pathway.