右美托咪定对颅内动脉瘤夹闭术患者脑血流动力学与氧代谢的影响

Impact of cerebral hemodynamics and oxygen metabolism of dexmedetomidine on patients with intracranial aneurysm surgery

目的 探讨右美托咪定对颅内动脉瘤夹闭术患者脑血流动力学与氧代谢的影响.方法 选择颅内动脉瘤夹闭术患者共64例,随机分为研究组和对照组,每组各32例.研究组麻醉诱导前给右美托咪定;对照组则给予等量生理盐水,诱导及麻醉方法同研究组.观察不用时间点平均动脉压（MAP）和心率及麻醉前、插管时、动脉瘤夹闭时脑氧代谢率（CMRO2）、脑血流量（CBF）、颅内压（ICP）变化,并观察两组复苏情况.结果 研究组插管时、插管后15 min、动脉瘤夹闭时、拔管时的MAP、心率均显著低于对照组（P均＜0.05）.研究组插管时、动脉瘤夹闭时的CMRO2较对照组显著升高[（34.2±5.0）％与（27.1±4.2）％,（33.9±4.3）％与（26.5±3.6）％;P均＜0.05],CBF较对照组显著降低[（53.5±8.8）ml/（100 g·min）与（67.3±11.2） ml/（100 g· min）,（56.8±9.2） ml/（100 g· min）与（67.3±11.2）ml/（100 g·min）,P均＜0.05],ICP较对照组亦显著降低[（136.6±12.1） mmH2O与（168.3±15.8）mmH2O,（138.5±14.5）mmH2O与（170.4±12.1）mmH2O,P均＜0.05].研究组自主呼吸恢复时间、拔管时间早于对照组[（7.35±1.12）h与（9.27±1.45）h,（12.98±3.76）h与（14.89±4.88） h;t值分别为10.92、9.23,P均＜0.01],Steward评分显著高于对照组[（5.12±0.33）分与（3.98±0.28）分;t =5.55、P＜0.05].结论 右美托咪定可稳定颅内动脉瘤夹闭术患者围术期血流动力学,提高脑氧摄取率,提高复苏效能,值得临床应用推广.

Objective To investigate the effects of cerebral hemodynamics and oxygen metabolism of dexmedetomidine on patients with intracranial aneurysm surgery.Methods Sixty-four patients with intracranial aneurysm surgery were collected and randomly divided into study group and control group （32 cases for each group）.Patients in the study group before induction of anesthesia were given dexmedetomidine and patients in the control group were given saline but anesthesia.Mean arterial pressure （MAP）,heart rate （HR）,cerebral metabolic rate of oxygen（CMRO2） in different time points were observed and time in intubation and intracranial aneurysm clamp before anesthesia were rescored.Cerebral blood flow （CBF）,intracranial pressure （ICP） were observed and the recovery situation.Results At the intubation,MAP and HR in the study group after 15 min of intubation,time in intracranial aneurysm clamp and extubation were significantly lower than those of the control group（P ＜ 0.05）.CMRO2 in study group at the intubation and intracranial aneurysm clamp were （34.2 ± 5.0） ％ and （27.1 ± 4.2）,significantly higher than that of the control group （（33.9 ± 4.3） ％,（26.5 ±3.6） ％; P ＜ 0.05）.CBF in study group at the intubation and intracranial aneurysm clamp were （53.5 ±8.8） ml/（100 g · min） and （56.8 ±9.2） ml/（100 g · min）,significantly lower than that of control group （（67.3±11.2） ml/（100 g· min）,（67.3 ±11.2） ml） （100 g· min）; P＜0.05） ; The same trend was seen in terms of ICP.Spontaneous breathing recovery time and extubation time in study group were （7.35 ± 1.12） h and（12.98 ± 3.76）,significantly earlier than those of the control group（（9.27 ± 1.45） h and （14.89 ±4.88） h; t =10.92,9.23,P ＜0.01）.Steward scores in study group was （5.12 ±0.33）,significantly higher than control group （（3.98 ± 0.28） ; t =5.55,P ＜ 0.05）.Conclusion Dexmedetomidine can certainly keep hemodynamic stability in patients with intracranial aneurysm surgery,improve rate of cerebral oxygen uptake and recovery performance,which is worthy of clinical application and promotion.