右美托咪定用于脑语言功能区手术麻醉中唤醒的观察

The observation of dexmedetomidine in the wake-up surgery of brain function language areas

目的：观察右美托咪定用于脑语言功能区全麻术中唤醒对清醒质量的影响。方法 ASAⅠ～Ⅱ级累及语言功能区全麻开颅手术患者20例,随机分为两组,其中右美托咪定组（ D组）10例,对照组（ C组）10例,开颅前两组均以丙泊酚＋瑞芬太尼＋肌松药维持麻醉,颅骨瓣打开后,D组改为右美托咪定0.5μg/（kg·h）替代,唤醒前及唤醒期减至0.1μg/（kg·h）维持。 C组唤醒前及唤醒期改为丙泊酚30μg/（kg·min）维持。分别观察两组的清醒时间、清醒期平均动脉压（ MAP）、心率（ HR）、血氧饱和度（ SpO2）、血气变化、清醒质量（包括意识、语言、指令、颅内压评分）以及不良反应。结果清醒时间D组明显短于C组,清醒期MAP和心率D组较C组更稳定,清醒质量D组明显优于C组,不良反应D组明显少于C组。结论右美托咪定独特的镇静类型,对呼吸几乎无抑制,非常适合术中唤醒用药,能提高全麻术中唤醒期的清醒质量,值得临床进一步应用研究。

Objective To observe the effects of the α2 adrenaline receptor agonists-Dexmedetomidine （ DEX） used in the wake-up surgery of brain function language areas. Method There were 20 patients of ASAⅠ～Ⅱthe brain function language area surgery with general anesthesia. Randomly divided into two groups, 10 cases of the Dexmedetomidine group （ group D） and 10 cases of the control group （ group C） , the two groups are the craniotomy with propofol add remifentanyl add muscle relaxant maintain anesthesia, when skull flap opens, two groups of stopping the anesthetic, group D to the right supporting the Dexmedetomidine 0. 5μg/（kg·h）, replacement, to wake up and before awaken-ing period to 0. 1μg/（kg·h）. The propofol of the group C were less to 30μg/（kg·min） before waking up. Respec-tively observe the two groups of the time of awake, and MAP, HR, SpO2 during awake period, blood gas analysis, clear quality （ including consciousness, language, instructions, intracranial pressure rating） and adverse reactions. Result Waking time of the group D was significantly shorter than the group C, awake period MAP and heart rate of the group D were more stable than group C, awake quality of the group D was obviously better than the group C, adverse reaction of the group D was significantly less than group C. Conclusion The sedation type of the Dexmedetomidine has no effect on breathing, is very suitable for intraoperative awaken medication, can improve the quality of intraoperative awakening period awake during anesthesia, is worthy of clinical application research further.