不同剂量右美托咪定滴鼻对全身麻醉插管期脑血流动力学的影响

Effects of Different Doses of Dexmedetomidine on Cerebral Hemodynamics during General Anesthesia

目的探讨不同剂量右美托咪定滴鼻对全身麻醉插管期脑血流动力学的影响。方法选择拟在全身麻醉下行颅内动脉瘤栓塞术患者120例,采用随机数字表法分为4组,对照组(C组)和不同剂量右美托咪定滴鼻(D 1组为0.5μg/kg、D 2组为1.0μg/kg、D 3组为2.0μg/kg),每组30例。全身麻醉诱导前30min,D 1、D 2、D 3组分别经鼻腔滴入右美托咪定0.5、1.0、2.0μg/kg,C组用等量0.9%NaCl溶液滴鼻,麻醉诱导后脑电双频谱指数值为40~60时进行气管插管。记录滴鼻30min时(T 0)、气管插管即刻(T 1)、插管后1min(T 2)、插管后3min(T 3)、插管后5min(T 4)各时间点的平均动脉压(MAP)、心率(HR)、左侧大脑中动脉峰值血流速度(Vp-MCA)、左侧大脑中动脉平均血流速度(Vm-MCA)、搏动指数(PI)。结果与组内T 0时比较,T 1~3时C组和D 1组MAP、Vp-MCA、Vm-MCA升高,HR增快,PI降低;T 1~4时D 3组MAP、Vp-MCA、Vm-MCA升高,HR减慢,PI降低,差异有统计学意义(P<0.05);与C组比较,T 1~3时D 2组MAP、Vp-MCA、Vm-MCA降低、HR减慢、PI增加;T 4时D 3组MAP、Vp-MCA、Vm-MCA增加、HR减慢、PI降低,差异有统计学意义(P<0.05);与D 1组比较,T 1~3时D 2组MAP、Vp-MCA、Vm-MCA降低、HR减慢、PI增加;T 4时D 3组MAP、Vp-MCA、Vm-MCA增加、HR减慢、PI降低,差异有统计学意义(P<0.05);与D 3组比较,T 1~4时D 2组MAP、Vp-MCA、Vm-MCA降低,HR减慢、PI增加,差异有统计学意义(P<0.05)。结论全身麻醉诱导前30min给予右美托咪定1.0μg/kg滴鼻能抑制气管插管刺激诱发的心血管反应和脑血流量增加。

Objective To investigate the effects of different doses of dexmedetomidine on cerebral hemodynamics during general anesthesia intubation.Methods Totally 120 patients with intracranial aneurysm embolization under general anesthesia were randomly divided into four groups,control group(group C)and different doses of dexmedetomidine(0.5μg/kg in group D 1,The D 2 group was 1.0μg/kg,and the D 3 group was 2.0μg/kg),30 cases in each group.30 minutes before induction of general anesthesia,D 1,D 2,and D 3 groups were intranasally instilled with dexmedetomidine 0.5,1.0,2.0μg/kg,and group C was intranasally instilled with the same amount of normal saline.Intubation between 40-60 for tracheal intubation.Mean arterial pressure(MAP)at 30 min(T 0),endotracheal intubation(T 1),1 min after intubation(T 2),3 min after intubation(T 3),and 5 min after intubation(T 4)were recorded.Heart rate,left cerebral artery peak blood flow velocity(Vp-MCA),left middle cerebral artery mean blood flow velocity(Vm-MCA),and pulsatility index.Results Compared with T 0 in the group,MAP,Vp-MCA,Vm-MCA increased,HR increased,and PI decreased in group C and group D 1 at T 1-3;MAP,Vp-MCA,Vm-MCA in group D 3 at T 1-4.The increase,HR slowed down,PI decreased,the difference was statistically significant(P<0.05).Compared with group C,D 1 group D 2 group MAP,Vp-MCA,Vm-MCA decreased,HR slowed,PI increased;At T 4,MAP,Vp-MCA,Vm-MCA,HR slowed down,and PI decreased in D 3 group,the difference was statistically significant(P<0.05).Compared with D 1 group,D 1 group MAP,Vp-MCA,T 1-3 Vm-MCA decreased,HR slowed down,and PI increased.At T 4,D 3 group increased MAP,Vp-MCA,Vm-MCA,HR slowed down,and PI decreased,the difference was statistically significant(P<0.05).Compared with D 3 group,At T 1-4,MAP,Vp-MCA and Vm-MCA in D 2 group decreased,HR slowed down and PI increased,and the difference was statistically significant(P<0.05).Conclusion Nasal drops of 1.0μg/kg dexmetomidine before induction of general anesthesia could inhibit cardiovascular response and increase of cerebral blood flow induced by tracheal intubation stimulation.