脑功能区胶质瘤切除术中应用右美托咪定复合瑞芬太尼对唤醒麻醉及血流动力学的影响

Effect of dexmedetomidine combined with remifentanil on awakening anesthesia and hemodynamics during resection of glioma in functional areas of the brain

目的研究右美托咪定复合瑞芬太尼用于脑功能区胶质瘤切除术中对唤醒麻醉及血流动力学的影响。方法选取2016年11月至2019年4月该院脑功能区胶质瘤切除术患者62例作为研究对象。将患者随机分为对照组28例,观察组34例。对照组采用丙泊酚复合瑞芬太尼维持麻醉,观察组采用右美托咪定复合瑞芬太尼维持麻醉。在麻醉诱导时(T0)、唤醒前20 min(T1)、唤醒时(T2)、唤醒后5 min(T3)及加深麻醉10 min(T4)等时间点,检测2组患者平均动脉压(MAP)、心率(HR)、血浆去甲肾上腺素(NE)、肾上腺素(E)的浓度,记录患者唤醒时间、唤醒前麻醉时间和唤醒前瑞芬太尼用量,并统计不良反应发生情况。结果与T0比较,对照组患者T1、T2、T3、T4和观察组患者T1、T2、T3的MAP、HR水平均升高,差异均有统计学意义(P<0.05)。与对照组比较,观察组患者T1、T2、T3、T4的MAP、HR更低,差异均有统计学意义(P<0.05)。与T0比较,对照组患者T1、T2、T3、T4和观察组患者T1、T2、T3的血浆NE、E水平均升高,差异均有统计学意义(P<0.05)。与对照组比较,观察组患者T1、T2、T3、T4的血浆NE、E水平更低,差异均有统计学意义(P<0.05)。对照组唤醒前的瑞芬太尼用量和HR加快、血压升高发生率均高于观察组,差异均有统计学意义(P<0.05)。结论右美托咪定复合瑞芬太尼用于脑功能区胶质瘤切除术中的唤醒麻醉效果显著,可以稳定血流动力学,减轻应激反应和不良反应,且不延长唤醒时间。

Objective To study the effect of dexmedetomidine combined with remifentanil on awakening anesthesia and hemodynamics during resection of glioma in functional areas of the brain.Methods A total of 62 patients undergoing glioma resection in the functional area of the brain from November 2016 to April 2019 were selected as the research objects.The patients were randomly divided into 28 cases in the control group and 34 cases in the observation group.The control group used propofol combined with remifentanil to maintain anesthesia;the observation group used dexmedetomidine combined with remifentanil to maintain anesthesia.Detection was performed at the time of induction of anesthesia(T0),20 min before awakening(T1),at awakening(T2),5 min after awakening(T3),and 10 min of deepening anesthesia(T4).The test content included the patient′s mean arterial pressure(MAP),heart rate(HR),plasma norepinephrine(NE),and epinephrine(E)concentration.In addition,the patient′s wake-up time,anesthesia time before wake-up,and remifentanil dosage before wake-up were recorded,and adverse reactions were counted.Results Compared with T0,the MAP and HR levels of T1,T2,T3,T4 in the control group and T1,T2,and T3 in the observation group increased,and the differences were statistically significant(P<0.05).Compared with the control group,the MAP and HR of T1,T2,T3,and T4 in the observation group were lower,and the differences were statistically significant(P<0.05).Compared with T0,the plasma NE and E concentrations of T1,T2,T3,T4 in the control group and T1,T2,and T3 in the observation group increased,and the differences were statistically significant(P<0.05).Compared with the control group,the plasma NE and E concentrations of T1,T2,T3,and T4 in the observation group were lower,and the differences were statistically significant(P<0.05).The dosage of remifentanil before awakening and the incidence of increased heart rate and blood pressure in the control group were higher than those in the observation group,and the differences were statistically significant(P<0.05).Conclusion Dexmedetomidine combined with remifentanil has a significant effect of wake-up anesthesia during resection of glioma in functional areas of the brain,which can stabilize hemodynamics,reduce stress and adverse reactions,and does not extend the wake-up time.