右美托咪啶对烟雾病颞肌贴敷术中脑氧代谢的影响

Effect of Dexmedetomidine on Oxygen Metabolism during Operation of Roofing of Temporal Muscle for Patients with Moyamoya Disease

目的 研究右美托咪啶对烟雾病患者颞肌贴敷术中脑氧代谢的影响.方法 选择我院择期行颞肌贴敷术治疗烟雾病患者60例,美国麻醉医师协会（ASA）分级Ⅱ～Ⅲ级,按照随机数字表法将其分为右美托咪啶组（D组）和对照组（C组）,各30例.麻醉诱导前D组静脉滴注右美托咪啶,C组静脉滴注等容量0.9％氯化钠溶液,10min内滴注完毕.术中D组予右美托咪啶0.4μg·kg-1·h-1持续泵注,C组则予等容量0.9％氯化钠注射液持续泵注.分别于给予右美托咪啶或0.9％氯化钠溶液前（T0）、气管插管前（T1）、气管插管后10 min （T2）、切皮即刻（T3）、打开硬膜即刻（T4）、颞肌贴敷即刻（T5）及关闭硬膜即刻（T6）采取桡动脉和右颈内静脉球部血样,血气分析后计算脑动脉-静脉血氧含量差（Da-jvO2）和脑氧摄取率（CERO2）,并观察患者平均动脉压（MAP）及心率（HR）变化.结果 与TO相比,D组在T1-T6时MAP、HR、Da-jvO2及CERO2均降低（P＜0.05）；D组在T1～T6时MAP、HR、Da-jvO2和CERO2均低于C组（P＜0.05）.结论 颞肌贴敷术中静脉滴注右美托咪啶可使血流动力学稳定,降低患者围麻醉期脑氧代谢率,维持脑氧供需平衡,利于脑保护,对提高手术效果和改善预后有积极作用.

Objective To investigate the effect of dexmedetomidine on oxygen metabolism during operation of roofing of temporal muscle for patients with moyamoya disease. Methods 60 patients with moyamoya disease who ASA class were II - III needing for roofing of temporal muscle admitted to our hospital were divided into dexmedetomidine group （ group D） and con- trol group （group C） according to random number table, in each of 30 cases. Group D was given dexmedetomidine, group C was given same dose of saline in 10 minutes before anesthesia induction. Group D was infused dexmedetomidine persistently by the rate of 0.4μg·kg-1·h-1 while group C was given saline by the same rate. Blood sample from radial artery and internal jug- ular vein were taken respectively at before administration of dexmedetomidine or saline （ TO ） , before endotraeheal intubation （T1） , 10 minutes after endotracheal intubation （T2） , skin incision （T3） , opening the dura mater （T4）, roofing the temporal muscle （T5） and occluding the dura mater （T6） for blood gas analysis. The arterio - venous oxygen content difference （ Da -jvO2） and cerebral oxygen extraction rate （CEROz） , MAP and HR were investigated. Results MAP, HR, Da - jvO2 and CERO2 at T1 - T6 in group D were lower than those of at TO （P 〈 0. 05） ; MAP, HR, Da - jvO2 and CERO2 at T1 - T6 in group D were lower than those of in group C （P 〈 0. 05）. Conclusion Dexmedetomidine can stable hemodynamic, decrease cerebral oxygen metabolism rate and balance the oxygen supply during operation of roofing of temporal muscle.