右美托咪定在颅内血肿清除术中的应用

Application of dexmedetomidine to clear intracranial hematoma

目的：观察右美托咪定在颅内血肿开颅清除术中的应用效果.方法：行颅内血肿清除术的患者38例,随机分为右美托米啶（M）组和对照（N）组.M组在10 min内静脉输注1 μg/kg右美托咪定,术中右美托米啶0.2~0.5 μg/（kg·h）泵注维持至切开硬脑膜后停药,N组泵注等容量生理盐水.观察用药前（T0）、用药后（T1）、气管插管前（T2）、气管插管后（T3）、手术后即刻（T4）、手术后60 min（T5）和手术结束时（T6）各时点SBP、DBP、MAP和HR值,记录术中的丙泊酚用量和血管活性药物的用量.结果：M组T0~T6各时点间,SBP、DBP和MAP差异无统计学意义（P〉0.05）,T1~T6各时点HR差异无统计学意义（P〉0.05）,均明显低于T0时点（P〈0.01）.N组T2时点SBP、DBP、MAP和HR明显低于T3~T6各时点（P〈0.01）.右美托咪定组的丙泊酚用量和麻黄碱的使用例数显著少于对照组（P〈0.01）.结论：右美托咪定可以使颅内血肿清除术的血流动力学平稳,并节约丙泊酚的用量.

Objective To observe the application effect of dexmedetornldlne to clear intracrauial hematoma. Method 38 patient suffer- ing from clearing the intraerauial hematoma,were divided into dexmedetomldine （M） group and control （N） group. M group had continuous intravenous infusion 1 μg/kg dexmedetomidine in 10 mln, in the operation dexmedetomidine was eontinuoued intravenous infusion 0. 2 - O. 5 μg,/（ kg. h） until the cut up dura mater, N group had equal capacity physiologleal saline infusions. Observed the SBP, DBP, MAP and HR values before drug （TO ） , after drug（ Tt ） ,before endotraeheal intubation （T2 ） and after endotracheal intubation （T3 ） ,immediately af- ter surgery （T4 ）, 60 minutes after surgery（T5 ） and at the end of the surgery （T6） , and recored consumptions of propofol and vasoaetive a- gents. Results Between the each point of To -T~ of M group, SBP, DBP and MAP had no statistic difference （P 〉 0. 05）, Between the each point of Tt - T6 of M group, HR had no statistic difference （P 〉 0. 05）, obviously was lower than the To point in time （ P 〈 0. 01 ）. SBP, DBP, MAP and HR of T2 point of N group were obviously lower than the T3 -T6 points in time （P 〈 0. 01 ）. Propofol requirements and the numbers of the use of the ephedrine of dexmedetomidine group were much less than that of thcontrol group （P 〈 0. 01 ） Conclusion Dexmedetomidine can make the hemodynamics of intraeranial hematoma removal surgery stable, and save prepofol require- ments.