围术期输注右美托咪定或舒芬太尼在颅脑损伤患者的应用

Application of perioperative infusion of dexmedetomidine or sufentanil in patients with traumatic craniocerebral injury

目的比较围术期输注右美托咪定或舒芬太尼在颅脑损伤患者的应用效果。方法静脉全身麻醉(全麻)下颅脑外伤手术患者120例随机均分为三组。D1组和D2组麻醉诱导前10 min内分别静脉输注右美托咪定0.5μg/kg和1.0μg/kg,随后以0.2~0.7μg·kg^(-1)·h^(-1)输注至术后72 h;S组麻醉诱导前10 min内输注舒芬太尼0.3μg/kg,随后以0.2~0.4μg·kg^(-1)·h^(-1)输注至术后72 h。麻醉期间维持脑电双频指数在50~70。记录麻醉诱导期MAP及HR。比较三组首次需要追加芬太尼和丙泊酚时间及两药总消耗量。观察不良反应发生情况。结果麻醉诱导期,D1组及D2组MAP及HR均低于S组(P<0.05)。与D1组和S组比较,D2组首次需要追加丙泊酚及芬太尼时间均延迟,且两药的总消耗量均减少(P<0.05)。D2组心动过速、高血压及呼吸抑制发生率低于D1组和S组(P<0.05)。结论在全麻下行颅脑损伤手术的患者,围术期输注右美托咪定较舒芬太尼能更有效增强麻醉效果,维持全麻诱导期循环稳定。

Objective To compare the efficacy of perioperative infusion of dexmedetomidine or sufentanil in the patients with craniocerebral injury.Methods One hundred and twenty patients undergoing the surgery for traumatic craniocerebral injury under intravenous general anesthesia were randomly divided into three groups with 40 cases each.Dexmedetomidine 0.5 μg/kg and 1.0 μg/kg were intravenously infused in 10 minutes before anesthesia induction in groups of D1 and D2,which were followed by dexmedetomidine 0.2~0.7 μg·kg^(-1)·h^(-1) infusion until 72 hours after surgery.Sufentanil 0.3 μg/kg was intravenously infused in 10 minutes before anesthesia induction in group S,which was followed by sufentanil 0.2~0.4 μg·kg^(-1)·h^(-1) infusion until 72 hours after surgery.Bispectral index of 50 to 70 was maintained during anesthesia.MAP and HR were recorded during anesthesia induction.The time for the first injection and total consumptions of fentanyl and propofol were compared among the three groups.The relevant adverse responses were observed.Results MAP and HR during anesthesia induction were lower in groups of D1 and D2 than those in group S(P<0.05).Compared with groups of D1 and S,the first use time of propofol and fentanyl in group D2 was significantly delayed and the total consumption of both drugs was significantly reduced(P<0.05).The incidence rates of tachycardia, hypertension and respiratory depression in group D2 were significantly lower than those in groups of D1 and S(P<0.05).Conclusion Perioperative dexmetomidine infusion is more effective than sufentanil in the maintenance of circulatory stability during induction in the patients undergoing the surgery for craniocerebral injury under general anesthesia.