右美托咪定对颅脑创伤急救患者麻醉诱导期血流动力学和脑电双频指数的影响

Effect of dexmedetomidine on hemodynamics and bispectral index in patients with craniocerebral trauma during anesthesia induction stage of first-aid

目的评价右美托咪定对颅脑创伤急救患者麻醉诱导期血流动力学和脑电双频指数的影响。方法入选80例颅脑创伤患者分成试验组和对照组,各40例。试验组静脉注射右美托咪定1μg·kg^-1照组静脉注射等量的生理盐水。观察2组患者在右美托咪定或生理盐水前（T0）、麻醉诱导前（T1）、气管插管前（T2）、气管插管完成即刻（T3）、完成1 min（T4）、完成3 min（T5）、完成5 min（T6）的平均动脉压、心率、脑电双频指数变化及不良反应发生情况。结果对照组T3~T5时的平均动脉压与T2时相比显著升高（P〈0.05）,T3、T4时的心率与T2时相比显著升高（P〈0.05）。试验组的平均动脉压和心率在T3、T4时明显低于对照组（P〈0.05）;试验组T1的脑电双频指数显著低于T0（P〈0.05）。2组患者T2~T6的脑电双频指数明显低于T0与T1（P〈0.05）;对照组T4、T5的脑电双频指数高于T2（P〈0.05）。试验组在T1、T4、T5时的脑电双频指数明显低于对照组（P〈0.05）。试验组不良反应发生率为7.5%,对照组无明显不良反应发生,差异无统计学意义（P〉0.05）。结论对于颅脑创伤患者麻醉诱导前使用右美托咪定能对患者产生明显镇静作用,可以有效抑制气管插管后3 min患者脑电双频指数的反应性的升高,同时患者的血流动力学更平稳。

Objective To observed the effect of dexmedetomidine on hemodynamics and bispectral index in patients with craniocerebral trauma during anesthesia induction stage of first - aid. Methods A total of 80 cases of patients with craniocerebral trauma were randomly divided into control group and trial group, with 40 cases in each group. Patients in trial group were given dexmedetomidine 1 μg·kg^-1 by intravenous infusion before anesthesia induction stage of first- aid within 15 min. In the control group, patients were given normal saline infusion before induction. Changes of mean arterial pressure, heart rate, bispectral index and adverse drug reaction in the two groups were recorded before dexmedetomidine or normal saline （ To ） , anesthesia induction （T1 ） , tra- chea cannula （T2 ）, the time that trachea cannula finished （T3 ）, 1 min after finish （ T4 ） , 3 rain after finish （ T5 ） and 5 rain after finish （ T6 ）. Results In control group, mean arterial pressure in T3 - Ts significantly increased compared with T2 （ P 〈 0. 05 ）, heart rate in stage T3 , T4 significantly increased compared with T2 （P 〈 0. 05 ） . Mean arterial pressure and heart rate of trial group in T3, T4 were significantly lower than those of control group （ P 〈 0. 05 ）. Bispectral index of trial group in T1 was significantly lower than that of To （ P 〈 0. 05 ）. Bispectral index at T2 - T6 in the two groups was significantly lower than that in the To and T1 （ P 〈 0. 05 ）. Bispectral index in T4, T5 of control group was higher than that in T2 （P 〈 0. 05 ）. Bispectral index of trial group at T1, T5, T5 was significantly lower than that of control group （P 〈 0. 05 ）. Total incidence of adverse drug reactions in trial group was 7.5 % and there was no significant adverse drug reaction in control group, there were no significantly difference （P 〉 0. 05 ）. Conclusion Dexmedetomidine had significant sedative effect on hemodynamics and bispectral index in patients with craniocerebral trauma during anesthesia induction stage Of first - aid, and could effectively inhibit reactively increase of bispectral index 3 min after trachea cannula, as well as make hemodynamics more stable.