盐酸右美托咪定对颅内动脉瘤介入手术患者血流动力学及术后并发症的影响

Effect of Dexmedetomidine Hydrochloride on hemodynamics and postoperative complications in patients with intracranial aneurysm undergoing interventional surgery

目的探讨颅内动脉瘤介入治疗过程中使用盐酸右美托咪定对患者血流动力学的影响及其颅内压(ICP)改变引起术后神经系统不良反应发生率的情况。方法选取2017年1月~2018年12月河北医科大学第一医院神经科确诊且择期行介入治疗的颅内动脉瘤患者96例为研究对象,依据选用的药物与使用剂量的不同将其分为盐水组(A组)、低剂量盐酸右美托咪定组(B1组)、高剂量盐酸右美托咪定组(B2组),每组32例。B1、B2组在手术结束前30 min开始泵入0.6、1.2μg/kg的盐酸右美托咪定,持续时间为20 min,A组泵入生理盐水。记录并比较三组患者术前(T0)、给药时刻(T1)、手术结束时刻(T2)、苏醒时刻(T3)、拔管时刻(T4)及拔管后(T5)ICP、平均动脉压(MAP)、心率(HR)及术后恢复相关指标(苏醒所需时间、术后拔管时间与Ramsay镇静评分),比较术后神经系统不良反应发生情况。结果B1组T2~T4时点ICP低于A组,T2~T5时点MAP、HR低于A组,差异均有统计学意义(均P<0.05),B2组T2~T4时点ICP低于A、B1组,T2~T5时点MAP低于A、B1组,T1~T5时点HR低于A、B1组,差异均有统计学意义(均P<0.05)。与A组比较,B1组苏醒所需时间、术后拔管时间差异无统计学意义(P>0.05);B1组Ramsay镇静评分高于A组,差异有统计学意义(P<0.05)。B2组苏醒所需时间、术后拔管时间长于A、B1组;Ramsay镇静评分高于A、B1组,差异有统计学意义(P<0.05)。三组术后神经系统不良反应发生率比较,差异有统计学意义(P<0.05)。B1、B2组神经系统不良反应发生率明显低于A组,差异均有统计学意义(均P<0.05);B1组与B2组神经系统不良反应发生率比较,差异无统计学意义(P>0.05)。结论手术结束前给予小剂量盐酸右美托咪定可以有效稳定患者血流动力学,改善脑组织灌注,降低ICP,减少术后神经系统不良反应发生。早期干预应用盐酸右美托咪定对颅内动脉瘤介入手术患者有一定的获益性应用价值。

Objective To investigate the effect of Dexmedetomidine Hydrochloride on hemodynamics and postoperative neurological adverse reactions caused by intracranial pressure(ICP)change during interventional therapy of intracranial aneurysm.Methods From January 2017 to December 2018,96 cases diagnosed as intracranial aneurysm and receiving elective interventional treatment in the First Hospital of Hebei Medical University were selected as subjects.They were divided into saline group(group A),low-dose Dexmedetomidine Hydrochloride group(group B1),and high-dose Dexmedetomidine Hydrochloride group(group B2)according to the drugs selected and the dose used,with 32 cases in each group.At the time of 30 minutes before ending surgery,Dexmedetomidine Hydrochloride was injected into B1 and B2 groups at 0.6μg/kg and 1.2μg/kg and continued for about 20 minutes,while group A was pumped in saline.ICP,mean arterial pressure(MAP)and heart rate(HR)of the three groups were recorded at the time of the preoperative(T0),administration(T1),ending surgery(T2),recovery(T3),extubation(T4)and post-extubation(T5).Postoperative recovery indicators(recovery time,postoperative extubation time and Ramsay sedation score)and incidence of neurological adverse reactions of three groups were compared.Results ICP of group B1 was lower than that of group A at T2-T4,MAP and HR of group B1 were lower than those of group A at T2-T5,and the differences were statistically significant(all P<0.05).At T2-T4,ICP of group B2 were lower than those of group A and B1,MAP of group B2 were lower than those of group A and B1 at T2-T5,HR of group B2 was lower than that of group A and B1 at T1-T5,and the differences were statistically significant(all P<0.05).Compared with group A,group B1 showed no statistically significant difference in the recovery time and postoperative extubation time(P>0.05).Ramsay sedation score in group B1 was higher than that in group A,with statistically significant difference(P<0.05).The recovery time and postoperative extubation time of group B2 were longer than those of group A and group B1,Ramsay sedation score of group B2 was higher than that of group A and group B1,and the differences were statistically significant(P<0.05).The incidence of postoperative adverse reactions in the nervous system of three groups were significantly differences(P<0.05).The incidence of adverse nervous system reactions in group B1 and B2 were significantly lower than those in group A,with statistically significant differences(all P<0.05).There was no significant difference in the incidence of neurological adverse reactions between group B1 and group B2(P>0.05).Conclusion Small doses of Dexmedetomidine Hydrochloride before ending surgery can effectively stabilize the hemodynamics of patients,improve cerebral perfusion,reduce intracranial pressure and the incidence of postoperative neurological adverse reactions.Early intervention with Dexmedetomidine Hydrochloride produces beneficial application value in patients with intracranial aneurysm undergoing interventional surgery.