右美托咪定对动脉瘤性蛛网膜下腔出血围介入栓塞手术期血流动力学以及继发脑血管痉挛发生的影响分析

Analysis of impact of dexmedetomidine on haemodynamics and occurrence of secondary cerebral vasospasm of aneurysmal subarachnoid hemorrhage during interventional embolization operative period

目的研究分析右美托咪定对动脉瘤性蛛网膜下腔出血围介入栓塞手术期血流动力学及继发脑血管痉挛发生的影响。方法 78例动脉瘤性蛛网膜下腔出血患者,随机分成研究组与对照组,每组39例。所有患者均行介入栓塞手术进行治疗,其中对照组术中实施常规气管插管麻醉,研究组手术麻醉中应用右美托咪定。观察分析两组患者的血流动力学变化及脑血管痉挛发生情况。结果两组麻醉前(T0)的心率(HR)、平均动脉压(MAP)比较差异均无统计学意义(P>0.05);研究组气管插管时(T1)、脑动脉造影时(T2)、气管拔管前(T3)、拔管后(T4)的HR、MAP均明显优于对照组,差异均具有统计学意义(P<0.05)。研究组术中造影脑血管痉挛发生率15.38%及术后症状性脑血管痉挛发生率7.69%均低于对照组的35.90%、25.64%,差异均具有统计学意义(P<0.05)。结论在动脉瘤性蛛网膜下腔出血患者的介入栓塞手术中应用右美托咪定,具有较高的临床应用价值。

Objective To study and analyze the impact of dexmedetomidine on haemodynamics and occurrence of secondary cerebral vasospasm of aneurysmal subarachnoid hemorrhage during interventional embolization operative period.Methods A total of78aneurysmal subarachnoid hemorrhage patients were randomly divided into research group and control group,with39cases in each group.All patients received interventional embolization operation for treatment,and the control group received conventional tracheal intubation anesthesia during operation.The research group received dexmedetomidine for anesthesia.Observation and analysis were made on hemodynamic changes and cerebral vasospasm occurrence in two groups.Results Both groups had no statistically significant difference in heart rate(HR)and mean arterial pressure(MAP)before anesthesia(T0)(P>0.05).The research group had obviously better HR and MAP at tracheal intubation(T1),cerebral angiography(T2),before tracheal extubation(T3)and after tracheal extubation(T4)than the control group,and their difference had statistical significance(P<0.05).The research group had incidence of intraoperative imaging cerebral vasospasm as15.38%and incidence of postoperative symptomatic cerebral vasospasm as7.69%,which were all lower than35.90%and25.64%in the control group,and their difference had statistical significance(P<0.05).Conclusion Application of dexmedetomidine in interventional embolization operation of aneurismal subarachnoid hemorrhage patients shows high clinical application value.