Dissertation > Excellent graduate degree dissertation topics show

Neuroprotective Effect of Dexmedetomidine in the Intracranial Aneurysm Surgery

Author: SongZhiLei
Tutor: HeCheng; MengFanMin
School: Henan University
Course: Surgery
Keywords: Dexmedetomidine Intracranial aneurysm S100βprotein NSE MMSE
CLC: R614
Type: Master's thesis
Year: 2013
Downloads: 4
Quote: 0
Read: Download Dissertation

Abstract


Background and ObjectiveIn cerebral aneurysm surgery,blocking tumor artery or clamping tumor easily happen vascularrupture and cerebral artery spasm.The pull,oppression or hemostatic to brain all can result in differentdegree and range of cerebral ischemic damage in operation process. How to reduce brain damage, protectbrain function more and more to be value. dexmedetomidine is a new type of alpha2adrenergic receptoragonist,. In animal studies, it has been reported that the dexmedetomidine have hippocampus neuronprotective. In the animal short cerebral ischemia experiments,dexmedetomidine can prevent ischemicneurological damage.NSE(neuron specific enolase)is a kind of intracellular proteins, specific consist in nerve cellsand neuroendocrine cells, glial cells and other cranial nerve tissue contains no NSE, so it is the markenzyme of neuron damage.Under normal circumstances, NSE content of body fluids is very low.Whenbrain is ischemic anaerobic damage,neurons degeneration necrosis, nerve demyelination, disintegration,the blood brain barrier damaged,NSE leak out from the neurons into peripheral blood and cerebrospinalfluid, it can be detected concentration increases in the blood, the quantity can reflect the damage degree ofneurons.S100β proteins are found in the astrocytes, oligodendrocytes of central nervous system andperipheral nerve schwann cells, are mark protein of glial cells.When cerebral ischemia damage the glialcells, β S100protein through the intercellular fluid into the cerebrospinal fluid, through the failure of theblood brain barrier-into the blood circulation. Therefore, the blood appear S100β protein can reflect glialcell injury and death, concentration and the damage degree of the brain.In the brain,distribution of NSE and β S100protein is different, combining detection can reflect neurons and glial cell damaged inbrain.NSE and β S100protein content can reflect the degree of brain injury.This study was to observe the dexmedetomidine have has brain protection in clinic,to providetheoretical basis for clinical application.Materials and methodsNinety patients,scheduled for brain Hemangioma surgery under general anesthesisa,wererandomly divided into three groups:dexmedetomidine group1(groupD1n=30),dexmedetomidine group2(groupD2n=30),normal saline control group(group C n=30)。When three groups patients got into the operating room, some Indexes such as electrocardiogram(ECG), heart rate (HR),Immediate arterial blood pressure (IBP),Pulse oxygen saturation (SpO2)and centralvenous indwelling (internal jugular vein).Then, give sufentanil,cisatracurium besylate, etomidateanesthesia induction intubation, intraoperative anesthesia. with remifentanil, propofol,cisatracuriumbesylate maintenance anesthesia.Group D1was administered dexmedetomidine (200mg diluted to50ml)intravenously at0.5μg/kg.h after a bolus infusion at1μg/kg.h for ten min。Group D2wasadministered intravenously at0.3μg/kg.h after a bolus infusion at0.5μg/kg.h for ten min。Group C wasgiven the same normal saline。Recording heart rate、 mean arterial pressure changes at seven timepoint:In to operation home T0、after anesthesiaT1, beginning of operation T2、 blocking the artery ofIntracranial aneurysm T3, blocking the Intracranial aneurysm T4、 cancel the blocking T5、end of thesurgery T6。 Recording the operation time and blocking the artery of Intracranial aneurysm time.Monitoring the concentration of S100β protein and neuron specific enolase(NSE)at five time points:,In tooperation home T0after surgery T6, after surgery six hours T7, after surgery12hours T8, after theoperation24hours T9.All of the patients in the preoperative one day and postoperative six day use mini-mental state examination(MMSE) test cognitive function and record score.With SPSS11.5software to carry on the analysis, the results use x sto show, measurementdata is used t test, p <0.05have statistical significance.ResultsThe heart rate within the groupD1and D2at T2、T3、T4、T5、T6time point is decreased obviously,compared with T0、T1time point,have statistical significance (p <0.05), compared with C group hasstatistical significance (p <0.05). Comparison of mean arterial pressure of three groups at different timepoints: D1, D2group have no changing significantly (p>0.05), fluctuating significantly in group C attime point preoperative (T0), intraoperation(T1、T2、T3、T4、T5), postoperative (T6)。 Comparing withgroupD1, D2at the each time point of intraoperation and postoperation,GroupD1, D2have obviouschanges (p <0.05). Comparison between group D1and groupD2has no statistical significance (p>0.05).The concentration of S100β protein of groupD1and D2at four time pointsT6,T7,T8,T9and theconcentration of neuron specific enolase(NSE)at tine point T9compared to the group C havestatistically significant(p<0.05)。Group D1compared to D2have no statistically significant (p>0.05). Scoreof MMSE record at postoperative six day of group D1and D2compared to the group C have nostatistically significant(p>0.05).GroupD1compared to D2have no statistically significant (p>0.05).Conclusions1、 Dexmedetomidine can reduce the concentration of S100β protein and NSE in theIntracranial aneurysm surgery,have neuroprotection.2、 Dexmedetomidine can maintain hemodynamic stability, maintain intracranial bloodsupply,provide the help of neuroprotective effect in the intracranial aneurysm surgery.3、MMSE test score,Dexmedetomidine group compared with control subjects have no obvious difference, that suggest dexmedetomidine has no apparent effect to postoperative cognitive dysfunction.

Related Dissertations

  1. Analysis of Causes of Death among Patients with Intracranial Aneurysms,R743.3
  2. Combined Detection of Tumor Markers in the Diagnosis and Treatment of Lung Cancer to Determine the Clinical Significance,R734.2
  3. The Effectiveness of Dexmedetomidine Infusion in Blind Nasotracheal Intubation,R614
  4. Significance of Intraoperative Indocyanine Green Fluorescence Videoagiography during Neurosurgical Procedure,R651.12
  5. The Change of Hearing P300 and the Mismatch Negativity in the Newly Parkinson’s Disease Patient Around Treatment and the Correlatead Research,R742.5
  6. Study of Diagnostic Value of Serum IGF-1 for Lung Cancer and Gastrointestinal Malignant Tumors,R730.4
  7. Effects of Lower Level Controlled Hypotension on Postoperative Cognitive Dysfunction in Patients affer Spinal Surgery,R614
  8. The Effect of Dexmedetomidine on Target Controlled Infusion (TCI) with Propofol for Sedation in Patients Undergoing Epidural Anesthesia,R614.3
  9. Effects of Different Loading Doses of Dexmedetomidine on Effect-site Concentration of Propofol Given by Target-controlled Infusion,R614
  10. The Effection Study on Visual Event-related Potentials P300 in Evaluating Clinical Character of Elderly Depression,R749.41
  11. Research on Relay Selection in Wireless Relay Network,TN925
  12. The Clinical Application of Dexmedetomidine in Functional Neurosurgery Operation,R614
  13. Based on multi-resolution clustering algorithm for secure localization,TN929.5
  14. Clinical Utility of Multiple Tumor Markers in Differential Diagnosis of Lung Cancer,R734.2
  15. Comparison of Sevoflurane and Propofol in Patients Undergoing Aneurysm Clamping Operations,R614
  16. The Effects of Dexmedetomidine on Target-controlled Infusion of Propofol and Stress Reaction for Laparoscopic Cholecystectomy,R614
  17. The Study of Brain Tiusse’s β-APP, Serum NSE and S100 in Rats after Severe Traumatic Brain Injury,R651.1
  18. The Clinical Study on the Accuracy of the Application of Bispectral Index in Monitoring Sedation with Dexmedetomidine,R614
  19. The Influence of Different Doses of Dexmedetomidine on Hemodynamic and Effect of Propofol Given by Target-controlled Infusion,R614
  20. Cost-effectiveness Analysis on Addition of a New Sedative and Analgesic Drug Dexmedetomidine Hydrochloride to General Anesthesia Program,R614
  21. Influence of Electroacupuncture before Operation on Post-operative Cognitive Dysfunction in Elderly Patients Undergoing Total Hip Joint or Total Knee Replacement,R614

CLC: > Medicine, health > Surgery > Surgical operation > Anesthesiology
© 2012 www.DissertationTopic.Net  Mobile