右美托咪定对颅内动脉瘤患者围拔管期应激反应和苏醒质量的影响

目的:观察右美托咪定(Dexmedetomidine,Dex)对颅内动脉瘤患者围拔管期应激反应和苏醒质量的影响。方法:选择Hunt/ Hess分级为I～II 级的施行颅内动脉瘤夹闭术患者50 例。随机分成右美托咪定(A组)和生理盐水对照组 (B组) ,每组25例。A组麻醉前 10 min 微泵静脉注射右美托咪定 0.5 μg/kg,术中 0.4 μg·kg^-1·h^-1持续泵注,B组给予等容量的0.9%的氯化钠注射液。两组均采用静吸复合全麻。记录入手术室时(T₁)、拔管即刻(T₂)、拔管后 5 min(T₃)、10 min(T₄) 的血压(BP)、心率(HR)变化,抽外周静脉血测定皮质醇(COR)、血糖(GLU)、血乳酸(LAC)浓度, 并记录麻醉恢复时间,苏醒期躁动评分、拔管后 30 min 视觉模拟(VAS)镇痛评分和Ramsay镇静程度评分。结果:B组的MAP、HR、COR、GLU、LAC较A组增高更为明显(P<0.01 或P<0.05);B组苏醒期躁动评分和拔管后 30 min VAS评分高于A组,而Ramsay镇静程度评分低于A组(P<0.05)。结论:右美托咪定有效抑制了围拔管期的应激反应,能提高麻醉苏醒质量,不延迟苏醒时间。

Effects of dexmedetomidine to intracranial aneurysms with stress response and awakening quality on tracheal extubation

AIM: To observe the effect of dexmedetomidine on intracranial aneurysms with stress response and awakening quality on tracheal extubation.METHODS: Select Hunt / Hess grading as I-II-class implementation of intracranial aneurysm surgery patients 50 cases, and randomly divided into dexmedetomidine group (group A) and normal saline group (group B), 25 patients in each. Group A were given dexmedetomidine with 0.5 μg/kg continuous infusion for 10 min before anesthesia, intraoperative 0.4 μg·kg^-1·h^-1 continuous infusion. Group B were given the same dose of 0.9% sodium chloride injection. Both groups were treated with combined intravenous-inhalation anesthesia. We recorded the changes of blood pressure (BP) and heart rate (HR) at into the operating room (T₁),extubation (T₂), extubation after 5 min (T₃), 10 min (T₄),measured the concentration of cortisol (COR), blood glucose (GLU), blood lactate (LAC), and recorded anesthesia recovery time,restlessness rating,visual analogue pain scores (VAS) and Ramsay sedation scores after extubation 30 min.RESULTS: The MBP, HR, COR, GLU, LAC of Group B increased more significantly (P<0.01 or P<0.05) than group A. Group B restlessness score and at VAS score 30 minutes after extubation were higher than those of group A, but Ramsay sedation scores were lower in group A (P<0.05).CONCLUSION: Dexmedetomidine can effectively inhibit the stress response to tracheal extubation period, can improve the quality of recovery from anesthesia, do not delay recovery.