右美托咪定对DSA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(dexmedetomidine,Dex)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。方法回顾性分析我院给予Dex镇静(Dex组)及予以咪达唑仑(Midazolam,Mid)镇静(Mid组)的DSA患者各58例临床资料。记录两组镇静前(T0)、置管5 min后(T1)、造影结束前10 min(T2)及T3(术后1h)镇静程度[Ramsay镇静评分(Ramsay sedation scores,RSS)]变化情况,并比较两组T0、T1、T2时疼痛状况[视觉模拟评分(visual analogue score,VAS)]、血流动力学[平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)]、氧化应激反应[超氧化物歧化酶(superoxide dismutase,SOD)、丙二醛(malondialdehyde,MDA)]及脑氧代谢[颈静脉球部血氧饱和度(blood oxygen saturation of jugular vein,SjvO2)、颈内静脉血氧含量(internal jugular venous oxygen content,CjvO2)]差异。结果两组镇静程度(RSS评分)变化情况均为T0<T3<T1<T2(P<0.05),且Dex组T1、T2时低于Mid组(P<0.05);两组T3时RSS评分比较,差异无统计学意义(P>0.05)。两组血流动力学(MAP、HR)变化情况均为T0>T1>T2(P<0.05),且Dex组T1、T2时低于Mid组(P<0.05)。两组血清SOD变化情况均为T0>T1>T2(P<0.05),且Dex组T1、T2时高于Mid组(P<0.05);血清部分氧化应激反应指标(MDA水平)及疼痛程度(VAS评分)变化情况均为T0<T1<T2(P<0.05),且Dex组T1、T2时低于Mid组(P<0.05)。两组脑氧代谢(SjvO2、CjvO2)变化情况均为T0<T1<T2(P<0.05),且Dex组T1、T2时高于Mid组(P<0.05)。结论Dex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(Dex)on perioperative sedation and cerebral oxygen metabolism in patients with digital subtraction angiography(DSA).Methods The clinical data of each 58 patients with DSA who were given Dex sedation(Dex group)or Midazolam(Mid)sedation(Mid group)were retrospectively analyzed in our hospital.The sedation[Ramsay sedation score(RSS)]was recorded in the two groups before sedation(T0),after 5 min of catheterization(T1),at 10 min before the end of angiography(T2)and at 1h after surgery(T3).The pain status[visual analogue score(VAS)],hemodynamics[mean arterial pressure(MAP),heart rate(HR)],oxidative stress response[superoxide dismutase(SOD),malondialdehyde(MDA)]and cerebral oxygen metabolism[blood oxygen saturation of jugular vein(SjvO2),internal jugular venous oxygen content(CjvO2)]were compared between the two groups at T0,T1 and T2.Results The sedation degree(RSS score)of the two groups showed that T0<T3<T1<T2(P<0.05),and the score in Dex group was lower than that in Mid group at T1 and T2(P<0.05).There was no statistically significant difference in the RSS score between the two groups at T3(P>0.05).The changes of hemodynamics(MAP,HR)in the two groups showed that T0>T1>T2(P<0.05),and the indexes at T1 and T2 in Dex group were lower than those in Mid group(P<0.05).The changes of serum SOD in both groups showed that T0>T1>T2(P<0.05),and the index at T1 and T2 in Dex group was higher than that in Mid group(P<0.05).The partial serum oxidative stress response index(MDA level)and pain level(VAS score)showed that T0<T1<T2(P<0.05),and the level and score at T1 and T2 in Dex group were lower than those in Mid group(P<0.05).The changes of cerebral oxygen metabolism(SjvO2,CjvO2)in both groups showed that T0<T1<T2(P<0.05),and the two indexes at T1 and T2 in Dex group were higher than those in Mid group(P<0.05).Conclusion Dex can effectively alleviate intraoperative oxidative stress of DSA,promote hemodynamic stability,and help improve cerebral oxygen metabolism.