右美托咪定对神经外科手术唤醒试验中应激反应的影响

Effects of dexmedetomidine on stress responses during wake-up test in neurosurgery

目的探讨右美托咪定对神经外科手术患者麻醉唤醒试验中应激反应的影响。方法选择在我院行神经外科手术患者97例作为研究对象,随机分为观察组及对照组。观察组48例,于麻醉诱导前10 min开始使用0.8μg/kg的右美托咪定进行静脉输注,并以0.4μg/(kg·h)速率维持;对照组49例,在相同时间点以等量生理盐水进行静脉输注。于唤醒试验前30 min停止使用丙泊酚和肌松药,观察记录两组唤醒时间、唤醒前麻醉时间、唤醒前麻醉药用量以及T1(唤醒前30 min)、T2(唤醒时)、T3(唤醒后5 min)、T4(唤醒试验后加深麻醉10 min)时间点的心率(HR)、平均血压(MAP)及脑电双频指数(BIS),比较两组不良反应发生情况。结果两组的唤醒时间及唤醒前麻醉时间比较无统计学差异(P>0.05);观察组唤醒前丙泊酚用量及芬太尼用量均显著低于对照组(P<0.05),各时间点HR均低于对照组(P<0.05);两组各时间点MAP及BIS均无统计学差异(P>0.05)。在T2、T3时间点,两组血流动力学指标均显著高于T1时(P<0.05),而在T4时恢复。观察组不良反应发生率(14.58%)显著低于对照组(83.67%)(P<0.05)。结论右美托咪定可抑制神经外科手术患者麻醉唤醒试验中的应激反应,安全性高,对于提高唤醒试验质量具有重要的临床意义。

Objective To explore the effects of dexmedetomidine on stress responses during wake-up test on patients undergoing neurosurgery, Methods A total of 97 patients underwent neurosurgery in our hospital were selected and randomly divided into an observation group（n=48） and a control group（n=49）. The observation group was administrated with 0.8μg/kg dexmedetomidine through intravenous infusion at the speed of 0.4μg/（kg·h） 10 min before anesthesia induction. The control group was administrated with the same amount of normal saline at the same time point also through intravenous infusion. The administration of propofol and muscle relaxant was stopped 30 min before the wake-up test to observe the wake-up time, anesthetic time before wake-up, anesthetic dosage before wake-up and the HR, MAP and BIS at T1 （30 min before wake-up）, T2 （upon wake-up）, T3 （5 min after wake-up） and T4 （10 min after deepened anesthesia after wake-up test） to compare the incidence of adverse reactions in the two groups. Results The difference in the wake-up times and that in the anesthetic times before wake-up between the two groups had no statistical difference （P 〉 0.05）; the dosages of propofol and remifentanil before wake-up in the observation group were lower than those in the control group（P 〈 0.05）; the HR at each time point was also lower than that in the control group（P 〈 0.05）; there was no significant difference of MAP and BIS at each time point between the two groups（P 〉 0.05）. The hemodynamic indexes at T2 and T3 in the two groups were significantly higher than those at T1 （P 〈 0.05） and restored at T4. The incidence （14.58%） of adverse reactions in the observation group was significantly lower than that （83.67%） in the control group（P 〈 0.05）.Conclusion Dexmedetomidine can inhibit the stress responses during wake-up test on patients undergoing neurosurgery, is highly safe and has great clinical significance for improving the quality of wake-up test.