右美托咪啶在神经外科麻醉中的应用进展

Application progress of dexmedetomidine in neurosurgery anesthesia

右美托咪啶是新一代高选择性α2-肾上腺素能受体激动剂,水中极易溶解,在甲醇、无水乙醇中易溶。右美托咪啶为有效的α2-肾上腺素受体激动剂,对α2-肾上腺素受体的亲和力比可乐定高8倍,临床上适用于重病监护治疗期间开始插管和使用呼吸机患者的镇静,具有镇静、镇痛及抑制交感神经活性、易唤醒的特点,在神经外科手术中得到广泛应用。颅内肿瘤手术患者采用右美托咪啶可稳定血流动力学及保护脑组织。此药物具有最小的神经生理学监测及较小的脑血流动力学波动,可较好实现镇静、镇痛效果。但是右美托咪啶可能导致严重的心动过速及高血压现象,因此对于全身血流动力学不稳定或者脑灌注受损患者应慎用。本文综述了右美托咪啶的药代动力学及临床作用,将神经外科麻醉中(功能神经外科手术、颅内肿瘤手术和脑深部电刺激术等)右美托咪啶的应用进行了总结,发现功能神经外科手术麻醉中应用右美托咪啶能够有效辅助手术进行,值得临床推广作用。

Dexmedetomidine is a new generation with high selectivityα2-adrenergic receptor agonist.It is most easily soluble in water,easily in methanol and absolute ethanol.Dexmedetomidine is an effective agonist ofα2-adrenoceptor agonists,and its affinity toα2-adrenoceptor is 8 times higher than clonidine.Clinically,it is suitable for sedation of patients who start intubation and use ventilator during intensive care and treatment.It has the characteristics of sedation,analgesia,inhibition of sympathetic nerve activity,and easy to wake up.It has been widely used in neurosurgery.In patients with intracranial tumor surgery,dexmedetomidine can stabilize hemodynamics and protect brain tissue.This drug has minimal neurophysiological monitoring and small cerebral hemodynamic fluctuations,and can achieve a good sedative and analgesic effect.But dexmedetomidine may cause severe tachycardia and hypertension.Therefore,patients with systemic hemodynamic instability or cerebral perfusion injury should be used with caution.This article reviews the pharmacokinetics and clinical effects of dexmedetomidine.The application of dexmedetomidine in neurosurgery anesthesia(functional neurosurgery,intracranial tumor surgery,deep brain stimulation,etc.)is summarized.It is found that the application of dexmedetomidine in functional neurosurgery anesthesia can effectively assist the operation,which is worthy of clinical promotion and application.