不同剂量右美托咪定在神经外科手术麻醉中的应用效果

Effects of different doses of dexmedetomidine applied to anesthesia during neurosurgery

目的比较不同剂量右美托咪定在神经外科手术麻醉中的应用效果。方法将84例择期行神经外科手术的患者按随机数字表法分为对照组、A组、B组和C组,每组21例。A组、B组和C组分别泵注0.2μg/(kg·h)、0.4μg/(kg·h)、0.8μg/(kg·h)右美托咪定,对照组输注生理盐水。记录4组患者在输注右美托咪定或生理盐水前(T0)、气管插管时(T1)、气管拔管时(T2)及气管拔管后10 min(T3)的平均动脉压(MAP)及心率。比较4组患者麻醉恢复期指标、围术期指标及麻醉恢复期不良事件发生情况。结果 4组患者MAP及心率差异均有统计学意义,均有随时间变化的趋势,分组与时间均有交互作用,其中在T1~T3时,4组患者MAP及心率由低到高均为C组<B组<A组<对照组(均P<0.05)。4组患者手术时间、麻醉时间、自主呼吸恢复时间、定向力恢复时间、拔除气管导管时间、窦性心动过缓及呛咳发生率比较,差异均无统计学意义(均P>0.05);4组患者拔除气管导管后10 min Richmond躁动镇静量表(RASS)评分、丙泊酚用量、瑞芬太尼用量由低到高均为C组<B组<A组<对照组(均P<0.05);C组与B组患者恶心呕吐、躁动发生率均低于对照组,且C组躁动发生率低于A组(均P<0.05)。结论不同剂量右美托咪定在神经外科手术麻醉中的应用效果不同,其中采用0.8μg/(kg·h)静脉泵注能保持患者血流动力学稳定,降低麻醉恢复期躁动发生率及丙泊酚、瑞芬太尼用量,不影响患者自主呼吸、定向力恢复及气管导管拔除时间。

Objective To compare the effects of different doses of dexmedetomidine applied to anesthesia during neurosurgel~/. Methods A total of 84 patients receiving elective neurosurgieal procedures were divided into control group, group A, group B and group C according to the random number table method,with 21 cases in each group. Group A, group B and group C were infused by pumping with dexmedetomidine 0.2 μg/（ kg · h） ,0.4 lag/（ kg · h ） and 0.8 μg/（ kg·h ） respectively, while the control group was infused with normal saline. The mean arterial pressure（MAP） and heart rate were compared among the four groups at the following time points,before infusion with dexmedetomidine or normal saline （ T0 ）, at the moment of tracheal intubation （ T1 ）, at the moment of tracheal extubation （T2）, and 10 min after tracheal extubation（ T3 ）. The indicators during anesthesia reeovery period, perioperative indicators, and incidence of adverse events during anesthesia reeovery period were compared between the four groups. Results There were significant differences in the MAP and heart rate among the four groups, MAP and heart rate changed over time, there was an interaction between grouping effect and time effect, and MAP and heart rate at T1 - T3 increased in the order of group C, group B, group A and the control group （ all P 〈 0.05 ）. There was no significant difference among the four groups in the operation duration, anesthesia duration, time to spontaneous breathing reeovery, time to directional force reeovery, time to tracheal catheter extraction, incidence rate of sinus bradyeardia, or incidence rate of choking cough （all P 〉 0.05 ）. The Richmond Agitation-Sedation Scale（RASS） score at 10 min after tracheal catheter extraction, propofol dosage and remifentanil dosage increased in the order of group C ,group B,group A and tire control group（all P 〈0. 05） ;the incidence rates of nausea, vomiting and agitation in group C and group B were lower than those in the control group, and the incidence rate of agitation in group C was lower than that in group A （ all P 〈 0. 05 ）. Conclusion Different doses of dexmedetomidine have different effects when applied to neurosurgieal procedures. Using intravenous pump infusion of 0. 8 μg/（ kg · h） of dexmedetomidine can achieve the patient＇s hemodynamie stability,reduce tire incidence rate of emergence agitation, deerease tire dosages of propofol and remifentanil, and does not affect tire time to spontaneous breathing reeovery,direetional force reeovery or tracheal catheter extraction.