右美托咪定和阿芬太尼对开颅动脉瘤夹闭术后恢复期的影响

Effect of Dexmedetomidine and Alfentanil on Post-operation Recovery Period after Aneurysm Clipping by Craniotomy

目的比较右美托咪定和阿芬太尼对全麻开颅动脉瘤夹闭患者术后恢复期呼吸、循环和苏醒情况的影响。方法本研究是一个随机临床对照试验。选择颅内未破裂动脉瘤患者90例,ASA分级Ⅰ~Ⅱ级,体质指数(BMI)20~25kg/m^2,在静吸复合全身麻醉下行开颅动脉瘤夹闭术。患者随机分为三组:右美托咪定组(n=30)、阿芬太尼组(n=30)和对照组(n=30)。手术结束前右美托咪定组泵注0.5μg/kg的美托咪定5min;阿芬太尼组给予阿芬太尼10μg/kg;对照组给予稀释到等容量的生理盐水。术后患者送入麻醉监护病房(PACU),观察并记录术后恢复期不同时间点:到达PACU(T_0),拔管时(T_1)和拔管后10min(T_2)的血流动力学指标,T_2时的呼吸频率和镇静评分以及拔管时间。结果三组患者术后的血流动力学指标、呼吸频率和拔管后镇静评分差异均有统计学意义(P<0.05),拔管时间差异无统计学意义(P>0.05)。结论右美托咪定和阿芬太尼均能使开颅动脉瘤夹闭患者术后恢复期血流动力学更加稳定,有更优的术后镇静,且不延长术后拔管时间,右美托咪定比阿芬太尼有更好的呼吸保护作用。

Objective To compare effect of Dexmedetomidine and Alfentanil on breath,blood circulation and analepsia in post-operation recovery period after aneurysm clipping by craniotomy with general anesthesia. Methods This study was designed as a randomized controlled trial. 90 cases of unruptured intracranial aneurysm patients, graded ASA I-II, whose body mass index （BMI） ranging from 20 to 25kg/m2, were included to undergo aneurysm clipping by craniotomy under intravenous-inhalation com- bined general anesthesia. Patients were randomly divided into three groups ： Dexmedetomidine group （n = 30）, Alfentanil group（ n =30） and control group（ n = 30）. Before the end of surgery ,0. 5 p,g/kg of Dexmedetomidine was administrated by computerized infusion pump for 5min in Dexmedetomidine group, 10p, g/kg of Alfentanil was given in Alfentani] group and in the control group ,equal volume of normal saline was given. Patients were transferred to Post Anesthesia Care Unit（PACU） after surgery. Haemodynamics indexes at different time points of post-operation recovery period （time of reaching PACU defined as TO , time of extubation defined as T j and 10 minutes after extubation defined as T2 ） ,respiratory rates and sedation scores at T2, as well as extubation time were observed and re- corded. Results Differences of post-operation haemodynamics indexes, respiratory rates and sedation scores after extubation among three groups were statistically significant（ P 〈 0. 05 ） , but differences of extubation time were not statistically significant （P 〉 0. 05 ）. Conclusion Dexmedetomidine and Alfentani] were able to make the haemodynamics more stable and post-operation sedation better in recovery period for patient just undergoing aneurysm clipping by craniotomy, without prolonging extubation time. Furthermore, Dexmedetomidine has better respiratory protective effect than Alfentanil.