右美托咪啶对开颅手术血流动力学的影响

Effect of Dexmedetomidine on hemodynamics in patients undergoing craniotomy

目的:探讨右美托咪啶(DEX)对开颅手术麻醉期间血流动力学的影响。方法:以60例拟行开颅手术的患者为研究对象,根据麻醉过程是否应用DEX和安慰剂随机分为安慰剂组(30例)和DEX组(30组)。术中七氟烷、阿片类药物以及血管活性药物常规应用以维持收缩压在90～130 mm Hg之间,心率在50～90次/min之间。监测的血流动力学指标由计算机系统连续地记录和储存并在两组之间进行比较。结果:DEX组的AUCSBP>130mmHg较安慰剂组明显较小[10(3～51)vs33(9～97),t=12.486,P=0.041),术中瑞芬太尼用量[(20.5±11.7)vs(27.2±13.4),t=2.381,P=0.031]以及需应用升压药物(33.3%vs 50.0%,χ2=15.72,P=0.026)、降压药物的患者(46.7%vs 80.0%,χ2=19.25,P=0.001)均较安慰剂组少。结论:DEX可以提高开颅手术患者的血流动力学稳定性,而没有增加低血压或心动过缓的发生率。

Objective： To investigate the effect of Dexmedetomidine（DEX） on hemodynamics in patients undergoing craniotomy.Methods： 60 patients scheduled for craniotomy were randomly divided into placebo group（30 cases） and DEX group（30 cases） according to whether placebo and DEX were used.Sevoflurane,Opioids and vasoactive medications were titrated in a routine manner to maintain systolic blood pressure（SBP） targeted within 90-130 mm Hg and heart rate（HR） within 50-90 times/min.Hemodynamic variables were continuously recorded and stored on a computer for analysis,and the results of two groups were compared.Results： AUCSBP130 mm Hg for patients in the DEX group for the targeted range above was significantly lower than placebo group [10（3-51） vs 33（9-97）,t=12.486,P=0.041].The DEX group required fewer Opioids than the placebo group in the intraoperative period [（20.5±11.7） vs（27.2±13.4）,t=2.381,P=0.031].A significant smaller proportion of patients with treatment of hypertensor（33.3% vs 50.0%,χ2=15.72,P=0.026） and antihypertensive agent（46.7% vs 80.0%,χ2=19.25,P=0.001） in the DEX group were fewer than the placebo group.Conclusion： Intraoperative DEX infusion is effective for blunting the increases in SBP.The use of DEX does not increase the incidence of hypotension or bradycardia,which are the common side effects of the drug.