右美托咪定对脑动静脉畸形栓塞术患者拔管应激反应的影响

Dexmedetomidine for extubation of brain arterlvenous malformations patients during general anaesthesia

目的观察右美托咪定对全身麻醉下行脑动静脉畸形栓塞术患者拔管应激反应的影响。方法 30例拟行全身麻醉下介入栓塞术的脑动静脉畸形患者,随机分为两组,D组(n=15)术中静脉输注右美托咪定0.5μg/(kg·h),P组(n=15)输注等容量生理盐水安慰剂。记录患者麻醉前、拔管即刻、拔管后1 5 min的血流动力学指标,检测血糖值及皮质醇浓度,记录麻醉苏醒时间、拔管时间和SAS镇静评分。结果与P组比较,D组患者血流动力学变化、镇静评分、苏醒时间与拔管时间基本相似,差异无统计学意义(P>0.05),拔管时血糖明显降低,差异有统计学意义(P<0.05),拔管后15 min恢复,血皮质醇的变化与血糖一致。结论右美托咪定可有效预防脑动脉瘤栓塞术患者全麻后的拔管应激反应。

Objective To evaluate the endocrine response of dexmedetomidine for extubation in brain arterivenous malformations patients who need endovascular embolization. Methods 30 patients with brain artefivenous malformations who required endovaseular embolization were randomly allocated to receive either dexmedetomidine 0. 5 μg/（ kg· h ） （Group D ） （ n = 15 ） and saline placebo（ Group P） （ n = 15 ） intravenously in a double - blind design after induction of general anesthesia. The bemodynamic parameters, SAS sedation score, extubation time, serum eortisol and blood glucose levels were measured and scored before anesthesia,during and after extubation 15 rain. Results The hemodynamic parameters, SAS sedation score and the time of tracheal extubation were similar in both groups. The serum blood glucose levels and eortisol concentrations were significantly lower in group D than in group P during and after extubations （ P 〈 0.05 ）. Conclusion Exmedetomidine do inhibit endocrine response for extubation in brain arterivenous malformations patients who need endovaseular embolization during general anaesthesia.