右美托咪定对老年颅内动脉瘤夹闭术患者血流动力学的影响

The influence of dexmedetomidine on hemodynamic in elderly patients undergoing intracranial aneurysm clipping

目的探讨右美托咪定(dexmedetomidine,Dex)对接受颅内动脉瘤夹闭术的老年患者围麻醉期血流动力学的影响。方法选择行颅内动脉瘤夹闭术的老年患者60例,采用随机数字表法将患者分为Dex组(D组)和对照组(C组),每组30例。D组患者持续泵注Dex(0.5μg·kg^-1·h^-1),C组患者持续泵注等量生理盐水至缝皮前。观察并比较两组患者入室时(T0)、气管插管时(T1)、插管后3 min(T2)、插管后5 min(T3)、瘤体分离完成(T4)、夹闭即刻(T5)、夹闭后30 min(T6)、拔管时(T7)及苏醒期(T8)SBP、DBP、心率、心排血量(cardiac output,CO)及心指数(cardiac index,CI)的变化,以及两组患者复苏情况和恢复期不良反应的发生率。结果D组T1~T6时SBP、T1~T4及T6时DBP、T1~T6时心率、T1~T4时CO、T1~T3及T6时CI明显低于C组,差异有统计学意义(P<0.05);与C组比较,D组停药至自主呼吸恢复时间、停药至拔管时间、苏醒期呼吸频率明显降低,Steward评分明显升高(P<0.05);D组患者恢复期谵妄发生率明显低于C组(P<0.05);两组患者其他不良反应发生率差异无统计学意义(P>0.05)。结论Dex可起到良好的稳定患者血流动力学的作用以及促进患者复苏的潜能,相对安全地应用于接受颅内动脉瘤夹闭术的老年患者中。

Objective To investigate the influence of dexmedetomidine on hemodynamics peri-anesthesia in elderly patients undergoing intracranial aneurysm clipping in perioperative period.Methods A total of sixty patients undergoing intracranial aneurysm clipping were randomly divided into the dexmedetomidine group(group D)and control group(group C)with 30 cases in each group using random number table.Patients in group D was administrated with Dex continuous infusion(0.5μg·kg^-1·h^-1)and patients in group C was infused equal dose of physiological saline until skin closure.The changes of systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate,cardiac output(CO)and cardiac index(CI)were observed and compared between the two groups,at patients entering the operation room(T0),at intubation(T1),3 min after intubation(T2),5 min after intubation(T3),at the time of completing tumor separation(T4),at the time of clipping(T5),30 min after clipping(T6),at extubation(T7),and recovery period(T8).Meanwhile,the recovery situation as well as the incidence of adverse events during recovery period was observed and recorded.Results The SBP recordings at T1-T6,DBP at T1-T4 and T6,heart rate at T1-T6,CO at T1-T4 as well as CI at T1-T3 and T6 of group D were statistically lower than the values at same time points in group C(P<0.05).The duration from drug withdrawal to spontaneous breathing recovery and the duration from drug withdrawal to extubation of group D were significantly shorter than the durations in the group C(P<0.05).The respiratory rate in group D was significantly lower than the rate in group C(P<0.05).The Steward score of group D was significantly higher than the score in the group C(P<0.05).The incidence of delirium in group D was significantly lower than the incidence in group C(P<0.05).Moreover,there was no significant difference in the incidence of other adverse events between two groups(P>0.05).Conclusions Dex play a positive role in stabilizing elderly patients′hemodynamics and have the potential clinical application values in promoting patients′resuscitation and safety in elderly patients undergoing intracranial aneurysm clipping.