Clinical effect of dexmedetomidine combined with landiolol hydrochloride on cerebral oxygen metabolism and inflammatory response in patients with severe craniocerebral injury.

objectiveTo study dexmedetomidine’s clinical effect and safety combined with landiolol hydrochloride on cerebral oxygen metabolism and inflammatory response in patients with severe craniocerebral injury.

methodsA retrospective analysis was conducted on 66 patients with severe craniocerebral injury underwent surgery between January 2018 and December 2023 in the neurosurgery department of the First Affiliated Hospital of Soochow University. The patients only treated with dexmedetomidine before anesthesia induction were classified as the control group, while the treatment group was treated with dexmedetomidine and landiolol hydrochloride. The levels of the cerebral oxygen metabolism indexes and inflammatory factors were obtained from all patients for analysis at five-time points: before anesthesia induction (T0), immediately after surgery (T1), 12 h after surgery (T2), 24 h after surgery (T3), and 72 h after surgery (T4). The cerebral injury-related indexes were obtained at 14 days after treatment. The cerebral oxygen metabolism indexes included the blood oxygen saturation of jugular vein bulb (SjvO2), the arteriovenous oxygen content difference (AvdO2) and the cerebral oxygen extraction rate (CerO2). The inflammatory factors included the serum concentration of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), neuron-specific enolase (NSE) and glial fibrillary acidic protein (GFAP). The cerebral injury-related indexes included the Glasgow Coma Scale (GCS) score, Glasgow Outcome Scale (GOS) score and the acute physiology and chronic health status II (APACHE II) score.

resultsCompared with T0, the SjvO2 were increased at T1, T2, T3, and T4 in two groups, while the CerO2 and the AvdO2 were decreased (P < 0.05). Compared with the control group, the SjvO2 were increased at T3 (P = 0.049) and T4 (P < 0.001), the AvdO2 and CerO2 were decreased at T1, T2, T3 and T4 in the treatment group (P < 0.001). Compared with T0, the serum concentration of TNF-α, IL-6, NSE and GFAP were increased at T1, T2, T3 and T4 in two groups (P < 0.05). Compared with the control group, these inflammatory factors were decreased at T1, T2, T3 and T4 in the treatment group (P < 0.001). After treatment, the GCS score was increased in two groups, while the APACHE II score was decreased (P < 0.05). Compared with the control group, the GCS score and the GOS score were higher in the treatment group, and the APACHE II score was lower (P < 0.001). There was no significant difference in the incidence of adverse reactions between the two groups. Compared with the control group, the 1-year survival rate of patients was higher in the treatment group(P = 0.022).

conclusionDexmedetomidine combined with landiolol hydrochloride used for patients with severe craniocerebral injury could reduce postoperative cerebral oxygen metabolism, alleviate inflammatory reactions, and improve brain function, which improves both short-term and long-term prognosis without increasing the incidence of adverse reactions.