摘要
目的探讨右美托咪定对颅内动脉瘤栓塞患者麻醉恢复质量的影响。方法选择ASA分级Ⅰ或Ⅱ级、Hunt⁃Hess分级0或Ⅰ级,择期行颅内动脉瘤栓塞的患者140例,采用随机数字表法分为3组:右美托咪定滴鼻组(A组,45例),患者在麻醉诱导前10 min给予右美托咪定0.5μg/kg滴鼻;右美托咪定静脉组(B组,47例),患者从麻醉诱导前10 min开始至手术结束持续静脉输注右美托咪定0.4μg·kg^(−1)·h^(−1);空白对照组(C组,48例),不给予右美托咪定。记录苏醒期患者咳嗽分级和Ricker镇静⁃躁动评分,麻醉诱导前(T_(0))、插管前(T_(1))、插管即刻(T_(2))、插管后1 min(T_(3))、动脉瘤栓塞前(T4)、栓塞结束(T_(5))、呼之睁眼时(T_(6))、拔管时(T_(7))和拔管后2 min(T_(8))时MAP和心率变化,术中丙泊酚及瑞芬太尼用量,停药至拔管时间,动脉瘤栓塞前后血糖和乳酸值,术前24 h和术后24 h简易智力状态检查量表(Mini⁃Mental State Examination,MMSE)评分以及苏醒期缺氧(SpO_(2)<90%)、喉痉挛等并发症发生情况。结果与C组比较,B组苏醒期呛咳和躁动发生率降低(P<0.05),A组差异无统计学意义(P>0.05)。与T_(0)时比较,A组T_(1)、T_(3)、T_(4)、T_(5)时和B组T_(1)、T_(3)、T_(4)时MAP均降低(P<0.05),3组患者各时点心率差异无统计学意义(P>0.05);与T_(5)时比较,A组和C组T_(6)、T_(7)、T_(8)时MAP明显升高,T_(7)、T_(8)时心率明显升高(P<0.05),B组MAP和心率差异无统计学意义(P>0.05);与B组比较,A组和C组T_(8)时心率较高(P<0.05);3组患者T_(6)、T_(7)、T_(8)时MAP比较差异无统计学意义(P>0.05)。3组患者丙泊酚及瑞芬太尼维持用量、停药至拔管时间、术前24 h和术后24 h MMSE评分比较差异均无统计学意义(P>0.05)。与栓塞前比较,A组和B组栓塞后血糖差异无统计学意义(P>0.05),C组栓塞结束时血糖指标有所升高,差异有统计学意义(P<0.05);与栓塞前比较,3组栓塞后乳酸差异均无统计学意义(P>0.05)。3组患者苏醒期均无缺氧、喉痉挛等并发症发生。结论在颅内动脉瘤栓塞中,右美托咪定静脉泵注可有效维持术中及苏醒期血流动力学稳定,降低苏醒期呛咳发生率,更有利于改善患者的恢复质量,且不会引起苏醒时间延长。
Objective To investigate the effects of dexmedetomidine on the recovery quality of patients undergoing intracranial aneurysm embolization.Methods A total of 140 patients,American Society of Anesthesiologists(ASA)gradeⅠorⅡ,Hunt‑Hess grades 0 orⅠ,who were scheduled for intracranial aneurysm embolization were enrolled.According to the random number table method,they were randomly divided into three groups:a nasal dexmedetomidine group(group A,n=45,which was nasally administered with 0.5μg/kg of dexmedetomidine 10 min before anesthesia induction),an intravenous dexmedetomidine group(group B,n=47,which was intravenously infused with dexmedetomidine at a rate of 0.4μg·kg^(−1)·h^(−1),10 min before anesthesia induction until the end of surgery),and a blank control group(group C,n=48,without administration of dexmedetomidine).The Ricker's sedation‑agitation score and the grade of cough during the recovery period were recorded.The mean arterial pressure(MAP)and heart rate were determined before anesthesia induction(T_(0)),before intubation(T_(1)),after intubation(T_(2)),1 min after intubation(T_(3)),before aneurysm embolization(T4),at the end of embolization(T_(5)),when the eyes opened(T_(6)),at extubation(T_(7)),and 2 min after extubation(T_(8)).The intraoperative dosage of propofol and remifentanil,the time from withdrawal to extubation,the levels of blood glucose and lactic acid before and after embolization of the aneurysms,the Mini‑Mental State Examination(MMSE)24 h before and 24 h after surgery and complications like hypoxia[pulse oxygen saturation(SpO_(2))<90%]and laryngospasm during the recovery period were recorded.Results Compared with group C,group B presented decreases in the incidence of cough and agitation during the recovery period(P<0.05),while no significant difference was found in group A(P>0.05).Compared with those at T_(0),decreases in MAP were found in group A at T_(1)、T_(3)、T_(4) and T_(5),and in group B at T_(1),T_(3) and T4(P<0.05),while no statistical difference was found in heart rate among the three groups at each time point(P>0.05).Compared with those at T_(5),groups A and C presented remarkable increases in MAP at T_(6),T_(7) and T_(8),and in heart rate at T_(7) and T_(8)(P<0.05),while no statistical difference in MAP and heart rate was found in group B(P>0.05).Compared with group B,groups A and C showed increases in heart rate at T_(8)(P<0.05),while no statistical difference was found in MAP among the three groups at T_(6),T_(7) and T_(8)(P>0.05).There was no statistical difference in the maintenance dosages of propofol and remifentanil,the time from withdrawal to extubation,and MMSE scores 24 h before and 24 h after operation among the three groups(P>0.05).Compared with those before embolization,there was no statistical difference in blood glucose between groups A and B after embolization(P>0.05).The blood glucose index remarkably increased in group C at the end of embolization(P<0.05).Compared with those before embolization,there was no statistical difference in lactic acid after embolization among the three groups(P>0.05).There were no complications such as hypoxia and laryngospasm during the recovery period.There were no complications such as hypoxia and laryngospasm among the three groups during the recovery period.Conclusions For intracranial aneurysm embolization,intravenous infusion of dexmedetomidine can effectively maintain hemodynamic stability during the surgery and the recovery period,reduce the incidence of cough during the recovery period,and improve recovery quality,without increases in the recovery time.
作者
李岩
王小慧
张久祥
白晓光
路志红
Li Yan;Wang Xiaohui;Zhang Jiuxiang;Bai Xiaoguang;Lu Zhihong(Department of Anesthesia and Perioperative Medicine,Xijing Hospital,Air Force Military Medical University,Xi'an 710032,China)
出处
《国际麻醉学与复苏杂志》
CAS
2021年第6期578-583,共6页
International Journal of Anesthesiology and Resuscitation
基金
国家自然科学基金(81871028,81701207)
陕西省科技重大专项一般项目(2018SF⁃277)
“人福”青年麻醉学医师科研基金(21800007)。
关键词
右美托咪定
颅内动脉瘤
栓塞术
麻醉恢复期
Dexmedetomidine
Intracranial aneurysm
Embolization
Anesthesia recovery period