右美托咪定对行数字减影血管造影患者围术期镇静及脑氧代谢的影响

Effects of Dexmedetomidine on Perioperative Sedation and Cerebral Oxygen Metabolism in DSA Patients

目的探究右美托咪定对数字减影血管造影(DSA)患者围术期镇静及脑氧代谢的影响。方法回顾性分析2017年3月-2018年12月行DSA患者104例的临床资料,按药物分为右美托咪定组和咪达唑仑组,每组52例。右美托咪定组给予右美托咪定镇静,咪达唑仑组给予咪达唑仑镇静。比较2组镇静前(T0)、置管5 min后(T1)、造影结束前10 min(T2)氧化应激反应、脑氧代谢、血流动力学、疼痛状况变化情况,并记录2组T0、T1、T2及术后1 h(T3)Ramsay镇静评分(RSS)变化情况。结果2组T1、T2血清超氧化物歧化酶(SOD)水平低于T0,且T2低于T1,但右美托咪定组高于咪达唑仑组(P<0.05);2组T1、T2血清丙二醛(MDA)水平高于T0,且T2高于T1,但右美托咪定组低于咪达唑仑组(P<0.05,P<0.01)。2组T1、T2颈静脉球部血氧饱和度(SjvO2)、颈内静脉血氧含量(CjvO2)均高于T0,且T2高于T1,右美托咪定组高于咪达唑仑组(P<0.05,P<0.01)。2组T1、T2平均动脉压(MAP)和心率低于T0,且T2低于T1,且右美托咪定组低于咪达唑仑组(P<0.05)。2组T1、T2视觉模拟评分法(VAS)评分均高于T0,但T2低于T1,右美托咪定组低于咪达唑仑组(P<0.05,P<0.01)。2组T1、T2、T3 RSS均高于T0,且T2高于T1,T3低于T1、T2,右美托咪定组T1、T2时低于咪达唑仑组(P<0.05,P<0.01)。结论右美托咪定能有效减轻DSA术中氧化应激反应,并促进机体血流动力学稳定,于改善患者脑氧代谢也有利。

Objective To investigate the effects of Dexmedetomidine on perioperative sedation and cerebral oxygen metabolism in patients undergoing digital subtraction angiography(DSA).Methods A retrospective analysis of the clinical data of 104 patients undergoing DSA from March 2017 to December 2018 was performed.They were divided into Dexmedetomidine group(n=52)and Midazolam group(n=52)according to drugs given.The Dexmedetomidine group was given Dexmedetomidine for sedation,and the Midazolam group was given Midazolam for sedation.The changes of oxidative stress response,cerebral oxygen metabolism,hemodynamics,and pain status before sedation(T0),at 5 min after catheterization(T1),and at 10 min before the end of angiography(T2)were compared.The changes in Ramsay sedation score(RSS)at T0,T1 and T2 and at 1 h after surgery(T3)were recorded in the two groups.Results The serum superoxide dismutase(SOD)levels at T1 and T2 in the two groups were lower than those at T0,and the levels at T2 was lower than those at T1,however,the levels in the Dexmedetomidine group were higher than those in the Midazolam group(P<0.05).The serum malondialdehyde(MDA)levels at T1 and T2 in the two groups were higher than those at T0,and the levels at T2 were higher than those at T1,however,the levels in the Dexmedetomidine group were lower than those in the Midazolam group(P<0.05,P<0.01).Both jugular bulb oxygen saturation(SjvO 2)and internal jugular vein oxygen content(CjvO 2)at T1 and T2 were higher than those at T0,and the above indicators at T2 was higher than those at T1,while the indicators in Dexmedetomidine group at T1 and T2 were higher than those in Midazolam group(P<0.05,P<0.01).Mean arterial pressure(MAP)and heart rate at T1 and T2 in the two groups were lower than those at T0,and the indicators at T2 were lower than those at T1,which were lower in Dexmedetomidine group than in Midazolam group(P<0.05).Visual analogue scoring(VAS)scores of both groups at T1 and T2 were higher than those at T0,which were lower at T2 than at T1,and the scores in Dexmedetomidine group at T1 and T2 were lower than those in Midazolam group(P<0.05,P<0.01).RSS of both groups at T1,T2 and T3 were higher than that at T0,which was higher at T2 than at T1,and was lower at T3 than at T1 and T2,and the RSS in Dexmedetomidine group at T1 and T2 was lower than that in Midazolam group(P<0.05,P<0.01).Conclusion Dexmedetomidine can effectively alleviate intraoperative oxidative stress of DSA,promote hemodynamic stability,and help improve cerebral oxygen metabolism.