诱导前泵注右美托咪定对颅内肿瘤切除术患者血氧饱和度的影响

Efficacy and safety of loading dosage of dexmedetomidine infusion in intracranial tumor patients

目的观察麻醉诱导前泵注右美托咪定对颅内肿瘤切除术患者血氧饱和度的影响。方法选取颅内肿瘤切除术患者(N组)及腹部手术患者(A组)各30例,年龄18～60岁,ASAⅠ或Ⅱ级。所有患者均于麻醉诱导前10min内静脉恒速泵注右美托咪定1μg/kg,随后以0.5μg·kg-1·h-1维持,同时静注芬太尼、丙泊酚和罗库溴铵行麻醉诱导,并气管插管。记录右美托咪定输注前(T1)、麻醉诱导前(T2)、气管插管前(T3)、插管时(T4)和插管后5min(T5)的SBP、DBP、HR和BIS,同时记录不良反应情况。结果 N组有1例患者在右美托咪定输注期间发生严重头痛而退出临床观察。与T1时比较,T2、T3时两组HR明显减慢,BIS明显下降(P<0.01)。在右美托咪定输注过程中,呼吸室内空气时N组有14例(48%)患者出现低血氧症(SpO2<90%),明显多于A组的6例(20%)(P<0.05)。结论与腹部手术患者相比,颅内肿瘤切除术患者麻醉诱导前静脉输注右美托咪定更易出现低氧血症。

Objective To compare the efficacy and safety of dexmedetomidine infusion among patients receiving intracranial tumor resection procedures versus abdominal operation. Methods Patients aged 18-60 years, male or female, ASAI or 1], scheduled for intracranial tumor resection （group N, n=30） and abdominal operation （group A, n--30） were enrolled in this observational trial. Dexmedetomidine was administrated with a loading dosage of 1 g/kg over 10 rain before anesthesia induction, followed by a constant infusion at a rate of. HR, BP, SpO2, BIS was recorded before dexinedetomidine injection （T1）, at the end of loading dose infusion （T2）, as well as before （T3）, during （T4） and 5 rain after （Ts） endotracheal intubation. Meanwhile side effects were record during this procedure, Results One patient in group N dropped out from this trial because of a serious headache taking place during dexmedetomidine infusion. Compared with T1, HR, SpO2 and BIS value decreased significantly at T2 and T3 in both groups （P〈0.01）. During dexmedetomidine infusion, while inhaling room air, 14 patients （14/29, 48 %） in group N suffered hypoxemia （SpO2 90%）, compared to 6 in group A （6/30, 20%） （P〈 0.05）. No other side effects were observed. Conclusion Compared with abdominal operation, patients receiving intracranial tumor resection procedures have a higher chance to suffer hypoxemia during intravenous injection of dexmedetomidine.