右美托咪定在颅脑手术麻醉中的应用

Application of dexmedetomidine in anesthesia of craniocerebral operation

目的观察在颅脑手术麻醉中使用右美托咪定对患者血流动力学及苏醒期质量的影响。方法选择2015年10月至2016年3月首都医科大学附属北京天坛医院拟于全身麻醉下行颅内幕上肿瘤切除术的患者36例，美国麻醉医师协会分级Ⅰ～Ⅱ级，按照随机数字表法分为右美托咪定组（18例）和对照组（18例）。麻醉诱导前，右美托咪定组给予右美托咪定负荷剂量1μg/kg（静脉泵注10rain），继以0．3μg／（kg·h）速度持续泵注，术毕前约30min停药；对照组以同样速率给予0．9％氯化钠注射液；术中以七氟烷和瑞芬太尼维持麻醉。记录并比较2组术后拔管和清醒时间，术中瑞芬太尼和血管活性药物的用量，围术期平均动脉压（MAP）、心率和脑电双频指数（BIS）的变化。结果2组术后拔管时间和清醒时间差异均无统计学意义（P〉0．05）。有美托咪定组瑞芬太尼用量明显低于对照组[0．052（0．035，0，067）mg比0．128（0．050，0．231）mg]，麻黄碱用量明显多于对照组[（1．39±0．34）mg比（0．56±0．12）mg]，差异均有统计学意义（均P〈0．05）；右美托咪定组未使用艾司洛尔，对照组艾司洛尔用量为（14±4）mg；2组阿托品和尼卡地平的用量差异无统计学意义（P〉0．05）。切皮开始时和关颅期右美托咪定组MAP明显低于对照组；在给予负荷剂量后、诱导期、手术中和手术后，右美托咪定组心率均明显低于对照组；右美托咪定组在给予负荷剂量后至手术开始，以及关颅期BIS值均明显低于对照组，差异均有统计学意义（均P〈0．05）。结论颅脑手术中使用有美托咪定可以增强围术期血流动力学的稳定性，减少麻醉药用量。

Objective To observe the effect of dexmedetomidine（DEX） on hemodynamics and quality of recovery of craniocerebral operation. Methods A total of 36 patients undergoing craniocerebral operation under general anesthesia （ American Society of Anesthesiologists grade Ⅰ～Ⅱ ） in Beijing Tian Tan Hospital, Capital Medical University from October 2015 to March 2016 were enrolled. The patients were randomly divided into DEX group and control group, with 18 cases in each group. The DEX group had DEX with 1 μg/kg initial loading dose before anesthesia induction and 0.3 μg/（ kg · h） maintenance dose ; the control group had 0.9% sodium chloride solution 0.3 μg/（ kg · h）; sevoflurane and remifentanil were used for anesthesia maintenance. Postoperative extubation time, anesthesia recovery time, intraoperative remifentanil and vasoactive drugs dosages, perioperative mean arterial pressure, heart rate and bispectral index were analyzed. Results Extubation time and anesthesia recovery time had no significant differences between groups（P 〉0. 05 ）. The dosage of remifentanil in DEX group was significantly lower than that in Control group [ 0. 052 （ 0. 035,0. 067 ） mg vs 0. 128 （ 0. 050,0. 231 ） mg ] （ P 〈 0. 05） ; the dosage of ephedrine in DEX group was significantly higher than that in control group [ （ 1.39 ± 0. 34）mg vs （0. 56 ±0. 12）mgl （P 〈0. 05） ; DEX group used no esmolol, the dosage of esmolol in control group was （14 ±4）mg; dosages of atropine and nicardipine had no significant differences between groups（ P 〉 0. 05 ）. Mean arterial pressures at skin incision and during cranial closure in DEX group were significantly lower than those in control group（ P 〈 0. 05 ）. Heart rates after administrating loading dose, during anesthesia induction, during and after operation in DEX group were significantly lower than those in control group （ P 〈 0.05 ）. Bispectral indexes after administrating loading dose and during cranial closure in DEX group were significantly lower than those in control group（P 〈 0. 05）. Conclusion DEX can improve hemodynamic stability and reduce dose of anesthetics during craniocerebral operation.