右美托咪定复合七氟醚在颅内动脉瘤介入栓塞术中的应用

Application of dexmedetomidine combined with sevoflurane in interventional embolization of intracranial aneurysm

目的观察右美托咪定复合七氟醚在颅内动脉瘤介入栓塞术中的应用效果和不良反应。方法选取2018年6月-2019年6月于河北医科大学第一医院行颅内动脉瘤介入栓塞术患者60例,随机分为右美托咪定组(A组)和对照组(B组),每组30例患者,两组患者根据监测脑电双频谱指数(BIS)调整全麻药用量。观察两组患者各时间点平均动脉压(MAP)和心率(HR)。比较两组患者术中应激反应指标和脑血管痉挛情况。比较两组患者七氟醚消耗量和术后躁动发生率及预后恢复情况。结果T_(1)~T_(5)各时间点A组MAP和HR明显低于B组(P<0.05);七氟醚消耗量A组明显少于B组(P<0.05);术后躁动发生率A组明显少于B组(P<0.05);术后皮质醇和肾上腺素A组明显少于B组(P<0.05);脑血管痉挛发生率A组明显少于B组(P<0.05);术后3个月GOS评分1~3分A组明显低于B组(P<0.05)。结论BIS监测下右美托咪定复合七氟醚在颅内动脉瘤介入栓塞术应用,可以减少七氟醚用量,抑制交感系统,用与颅内动脉瘤介入栓塞术中可以降低术后躁动发生率,减少脑血管痉挛发生率及预后不良风险,有很大的优势。

Objective To observe the effect of dexmedetomidine combined with sevoflurane in interventional embolization of intracranial aneurysms.Methods 60 patients undergoing interventional embolization of intracranial aneurysms were chosen in our hospital from June 2018 to June 2019,they were randomly divided into dexmedetomidine group(group A)and control group(group B)with 30 patients in each group.The dosage of general anesthetic was adjusted by bispectrial index(BIS)in the two groups.Mean arterial pressure(MAP)and heart rate(HR)at each time point in the two groups were observed.The hormone of stress response and cerebral vasospasm were compared between the two groups during the operation.Sevoflurane consumption,incidence of postoperative dysphoria and prognosis were compared between the two groups.Results MAP and HR in group A were significantly lower than those in group B at T1,T2,T3,T4,T5(P<0.05).Sevoflurane consumption in group A was significantly lower than in group B(P<0.05).The incidence of postoperative dysphoria in group A was less than that in group B(P<0.05).Postoperative cortisol and adrenaline in group A were significantly lower than those in group B(P<0.05).The incidence of cerebral vasospasm in group A was less than that in group B(P<0.05).The number of patients in group A with Glasgow Outcome Scale(GOS)score of 1-3 in 3 months after operation was significantly lower than that in group B(P<0.05).Conclusions Dexmedetomidine combined with sevoflurane under BIS monitoring has great advantages in interventional embolization of intracranial aneurysms,including reducing the dosage of sevoflurane and the incidence of postoperative dysphoria,inhibiting the sympathetic system,reducing the incidence of cerebral vasospasm and improving prognosis.