右美托咪定在颅内动脉瘤栓塞术患者插管中的效果及对应激反应和血液流变学的影响

Anesthetic effect of dexmedetomidine in intubation of patients undergoing intracranial aneurysm embolization and its influence on stress response and hemorheology

目的 探讨右美托咪定在颅内动脉瘤栓塞术患者插管中的麻醉效果及对应激反应和血液流变学的影响。方法 选择2019年3月至2021年3月颅内动脉瘤栓塞术患者96例为对象,随机数字表法分为对照组和观察组,每组48例。在麻醉诱导前,观察组10 min内微量泵泵入右美托咪定1μg/kg,随后以0.4μg·kg-1·h-1的速率持续泵注至手术结束前30 min,对照组泵入0.9%氯化钠溶液,给予相同方法麻醉诱导,经口明视下气管插管,记录2组入手术室平静休息3 min(T1)、气管内插管前(T2)、插管后即刻(T3)、插管后3 min(T4)舒张压、收缩压、心率;测定2组T1、T2、T3及T4时间点肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)水平,比较2组麻醉效果、应激反应、血液流变学、安全性。结果 观察组麻醉苏醒时间、拔管时间、Ramasay评分长(高)于对照组(P<0.05);拔管质量评分低于对照组(P<0.05);2组T2、T3时间点收缩压、舒张压及心率均低于T1时间点(P<0.05);观察组T2、T3时间点收缩压、舒张压及心率均高于对照组(P<0.05);2组T2、T3时间点TNF-α、IL-6水平均高于T1时间点(P<0.05);观察组T2、T3时间点TNF-α、IL-6水平低于对照组(P<0.05);2组麻醉期间安全性差异无统计意义(P>0.05)。结论 右美托咪定用于颅内动脉瘤栓塞术患者插管中能获得良好的麻醉效果,对患者应激反应较小,可稳定维持患者血流动力学水平,且未增加不良反应发生率,值得推广应用。

Objective To investigate the anesthetic effect of dexmedetomidine in the intubation of patients undergoing intracranial aneurysm embolization and its influence on stress response and hemorheology.Methods Ninety-six patients undergoing intracranial aneurysm embolization from March 2019 to March 2021 were selected as subjects,and they were randomly allocated to control group(n=48)and observation group(n=48).Before anesthesia induction,patients in the observation group were given continuous infusion of dexmedetomidine 1μg/kg using a micropump for 10min,followed by continuous infusion at 0.4μg·kg^(-1)·h^(-1) until 30min before the end of surgery,and those in the control group were given 0.9%normal saline.Anesthesia induction was similarly performed in both groups.Endotracheal intubation was carried out.The diastolic blood pressure(DBP),systolic blood pressure(SBP)and heart rate(HR)at 3 min rest in the operating room(T1),before endotracheal intubation(T2),immediately after intubation(T3),and 3 min after intubation(T4)were recorded.The levels of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)were determined at T1,T2,T3 and T4.Anesthesia effect,stress response,hemorheology and safety were compared between the two groups.Results Recovery time from anesthesia and extubation,and Ramasay scores were higher in the observation group than those in the control group(P<0.05).The extubation quality score was significantly lower in the observation group than that in the control group(P<0.05).SBP,DBP and HR at T2 and T3 in both groups were significantly lower than those at T1,which were much higher in observation group than those in control group(P<0.05).TNF-αand IL-6 levels at T2 and T3 in both groups were significantly higher than those at T1,which were significantly lower in the observation group than in the control group(P<0.05).The safety during anesthesia was comparable(P>0.05).Conclusion Dexmedetomidine can obtain a good anesthetic effect in the intubation of patients undergoing intracranial aneurysm embolization,which has less stress response,stably maintains the hemodynamic level without increasing the incidence of adverse events.It is worth promoting and applying.