右美托咪定复合瑞芬太尼用于脑功能区胶质瘤切除术中唤醒麻醉的临床观察

Dexmedetomidine combined with remifentanil in intraoperative wake-up test in functional neurosurgery

目的:观察右美托咪定复合瑞芬太尼在神经外科脑功能区胶质瘤术唤醒麻醉中的效果。方法:选择40例需行脑功能区胶质瘤切除的患者,(ASA)Ⅰ-Ⅱ级,随机分为右美托咪定复合瑞芬太尼观察组(A组)(n=20)和丙泊酚复合瑞芬太尼对照组(B组)(n=20),并应用两组方法行脑功能区胶质瘤切除手术术中唤醒麻醉。记录两组在术前(T0)及唤醒期间(T1)血压、心率、脉搏氧饱和度和呼吸频率的变化、唤醒时间、呛咳次数、体动次数。术后2d、7d、14d随访病人,了解患者精神伤害情况。结果:A、B两组术前血压、心率和呼吸抑制情况比较无差异(P>0.05),唤醒期间A组SBP、MAP、HR和呼吸抑制情况显著低于B组,有统计学意义(P<0.05),唤醒时间A组较短,明显短于B组(P<0.05),且呛咳次数及体动次数A组低于B组(P<0.05)。精神伤害的发生率两组无差异(P>0.05)。结论:右美托咪定复合瑞芬太尼应用于脑功能区胶质瘤切除术术中唤醒麻醉对病人血流动力学影响较小,病人苏醒快,不良事件发生率低,较丙泊酚复合瑞芬太尼有一定优势。

Objective：To observe the effect of dexmedetomidine combined with remifentanil in intraoperative wake - up test in functional neurosurgery. Methods： Forty neurosurgery patients, ASA I or , requiring intraoperative wake - up test during functional neurosurgery were randomly divided into two groups, 20 for each group. Wake - up test for location of brain domain was completeted using dexmedetomidine combined with remifentanil group （group A, n = 20 ） or propofol combined with remifentanil（group B, n = 20）. The change of BP, HR, SPO2 and RR in preoperative（To ） and awakening（ T1 ） ,wake -up time ,wake -up quality, bucking and agitation were recorded. Visit the patients at the time of 2 day,7 day and 14 day after the operation, and acquire the mental injury condition. Results：There was no significant difference in blood pressure, heart rate and respiratory depression in preoperative （ P 〉 0.05 ）. During the awakening, compared with group B, the SBP, MAP, HR and respiratory depression in group A was deceased（ P 〈 0.05） ; Patients in group A required less time for wake - up, had higher wake - up quality and had less incidences of bucking and agitation compared with group B（P 〈0.05）. There was no significant difference in mental injury condi- tion in both group（P 〉 0.05 ）. Conclusion：Compared with propofol combined with remifentanil, intraoperative wake -up test in functional neurosurgery has more advantages, with dexmedetomidine combined with remifentanil because of stable haemodynamics ,high waking quality and adverse events.