右美托咪啶对高血压患者开颅术麻醉的影响

Effect of dexmedetomidine on general anesthesia in hypertensive patients undergoing craniectomy

目的探讨右美托咪啶对高血压患者枕后开颅面神经显微血管减压术麻醉用药以及麻醉苏醒的影响。方法选择合并高血压病面神经显微减压术患者48例,随机分为两组,每组24例。研究组麻醉诱导前静脉微量泵入右美托咪啶负荷量(1μg/kg),继以维持0.2～0.7μg/(kg·h);对照组则微量泵入相同剂量的生理盐水。两组术中控制血压,收缩压维持在术前基础值的70%～80%。两组麻醉诱导选用丙泊酚、芬太尼和维库溴铵。以丙泊酚和瑞芬太尼持续泵注维持麻醉,观察两组患者麻醉药泵注速度、麻醉苏醒时间及拔管时间。结果研究组麻醉药泵注速度[丙泊酚(0.076±0.014)mg/(kg·min)vs(0.092±0.018)mg/(kg·min);瑞芬太尼(0.106±0.032)μg/(kg·min)vs(0.131±0.030)μg/(kg·min)]、麻醉苏醒时间[(5.2±2.1)min vs(9.3±2.4)min]及拔管时间[(5.3±2.4)min vs(10.3±3.2)min]与对照组相比差异均有统计学意义(P均<0.05)。结论右美托咪啶用于高血压患者枕后开颅术可明显减少麻醉用药量,缩短麻醉苏醒时间,加快拔管。

Objective To detect the effect of dexmedetomidine（DEX） on general anesthesia of hypertensive patients undergoing retromastoid craniectomy for microvascular decompression（MVD） of facial nerve.Methods 48（ASA Ⅰ-Ⅱ） hemifacial spasm patients with hypertension undergoing retromastoid craniectomy for MVD of facial nerve under general anesthesia were randomly divided into two groups： the study group and the control group.Dexmedetomidine was injected with the load dosage（1 μg/kg） before anesthesia,followed by the maintaining dosage [0.2-0.7 μg/（kg·h）] during anesthesia in the study group.Sodium chloride injection was pumped in the control group.Anesthesia was maintained with propofol and remifentanil.During the surgery,systolic blood pressure（SBP） was maintained 70%-80% of the baseline value by titration of anesthetic drugs and/or nitroglycerin in both groups.The mean infusion rates of propofol and remifentanil,anesthesia recovery and extubation times were observed.Results Compared with the control group,patients in the study group required lower normalized infusion rates of propofol [（0.076±0.014）mg/（kg·min） vs（0.092 ± 0.018）mg/（kg·min）,P0.05] and remifentanil [（0.106±0.032） vs（0.131±0.030）μg/（kg·min）,P0.05].Anesthesia recovery times [（5.2±2.1）min vs（9.3±2.4）min] and extubation times [（5.3±2.4）min vs（10.3±3.2）min] were also significantly shorter than those in the control group（P 0.05）.Conclusion Dexmedetomidine can effectively reduce the consumption of anesthetic drugs,shorten the recovery times and hasten the extubation in the hypertensive patients during retromastoid craniectomy under general anesthesia.