To observe the preventive effect of dexmedetomidine combined with sevoflurane on secondary injury after cerebral hemorrhage.

Using the nested case-control study method, 84 hypertensive patients with cerebral hemorrhage admitted to the Neurosurgery Department of Taizhou People's Hospital from January 2020 to December 2021 were selected as the study objects. The patients who received dexmedetomidine combined with sevoflurane during operation were treated as the dextromethorphane group (42 cases), and the patients who received sevoflurane during operation matching the baseline data were treated as the simple sevoflurane group (42 cases). The hemodynamic indexes [heart rate (HR), mean arterial pressure (MAP)], intraoperative vital signs [number of vasoactive drugs used, intraoperative blood pressure, operation time, intraoperative bleeding volume, incidence of bradycardia, and incidence of rescue events] of the two groups of patients at baseline anesthesia (t₀), 1 min (t₁), 2 min (t₂), 5 min (t₃) after anesthesia induction, and 1 min (t₄), 5 min (t₅), 10 min (t₆) after intubation were compared differences of related oxidative stress product indicators [malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px)], neurotransmitter indicators [vasopressin (VAP), neuropeptide Y (NPY), aspartic acid (Asp)].

(1) HR and MAP in the dextromethorphane group were lower than those in the simple sevoflurane group at t₀-t₆ time points (P<0.05). Compared with t₀ time point of the same group, HR and MAP of patients in the two groups tended to be stable at t₁-t₆ time points (P<0.05). (2) There was no significant difference between the two groups in terms of the number of vasoactive drugs used, the incidence of bradycardia, intraoperative blood pressure, intraoperative bleeding, operation time and the incidence of remedial events (P>0.05). (3) On the 1^st, 7^th and 10^th day after operation, the contents of SOD and GSH-Px in the dextromethorphane group were higher than those in the simple sevoflurane group, while the contents of MDA was lower than that in the simple sevoflurane group (P<0.05). Compared with the same group on the 1^st day after operation, the contents of SOD and GSH-Px in the dextromethorphane group decreased successively on the 7^th and 10^th day after operation, while MDA increased in turn, with statistically significant difference (P<0.05). (4) There was no significant difference in VAP, NPY and Asp between the two groups 1^st day after operation (P>0.05); At 7^th and 10^th day after operation, VAP, NPY and Asp in the dextromethorphane group were significantly lower than those in the simple sevoflurane group (P<0.05). Compared with the same group on the first day after operation, the VAP, NPY and Asp indexes of patients in the two groups decreased successively on the 7^th and 10^th day after operation (P<0.05).

Dextrmedetomidine combined with sevoflurane can improve hemodynamics, oxidative stress products and neurotransmitter levels in patients undergoing intracerebral hemorrhage surgery, thus preventing secondary injury after intracerebral hemorrhage surgery.