右美托咪啶与乌拉地尔对高血压脑出血患者术后拔管期应激反应、术后寒战及脑氧代谢的影响

The effects of dexmedetomidine and urapidil on postoperative extubation stress response,postoperative shivering,and cerebral oxygen metabolism in patients with hypertensive intracerebral hemorrhage

目的探讨右美托咪啶与乌拉地尔对高血压脑出血患者术后拔管期应激反应、术后寒战及脑氧代谢的影响。方法选取河北省第七人民医院2021年1月至2022年12月收治的120例高血压脑出血患者作为研究对象,按照随机数字表法分为观察组(60例)和对照组(60例)。所有患者均采取全身麻醉下的颅内血肿清除手术联合去骨瓣减压手术进行治疗,观察组患者术后采用右美托咪啶与乌拉地尔进行镇静镇痛,对照组患者术后采用右美托咪啶进行镇静镇痛。比较两组患者的生命体征、应激指标、脑氧以及脑糖代谢、不良反应之间的差异。结果两组入室后(T_(0))、麻醉用药前(T_(1))的HR、SBP、DBP、BIS比较差异均无统计学意义(均P>0.05),观察组患者拔管时(T_(2))、拔管后即刻(T_(3))、拔管后1 min(T_(4))、拔管后3 min(T_(5))的心率(HR)、收缩压(SBP)、舒张压(DBP)、脑电双频指数(BIS)显著低于对照组,差异均有统计学意义(均P<0.05)。两组患者T_(0)时的各项应激指标差异无统计学意义(均P>0.05),观察组患者T_(5)时的各项应激指标显著低于对照组(均P<0.05)。两组患者T_(0)时的脑氧摄取率(CERO_(2))、脑动静脉血糖含量差(A-VDG)差异无统计学意义(均P>0.05),观察组T_(5)时的CERO_(2)、A-VDG显著高于对照组(均P<0.05)。两组患者术后的低氧血症、低血压、心动过缓发生率差异无统计学意义(均P>0.05),观察组患者术后寒颤的发生率低于对照组(P<0.05)。两组患者术后格拉斯哥昏迷指数均高于术前(均P<0.05),术前、术后两组患者格拉斯哥昏迷指数比较差异无统计学意义(均P>0.05)。结论右美托咪啶与乌拉地尔对高血压脑出血患者术后拔管期应激反应、术后寒战及脑氧代谢均有明显改善作用,建议临床推广。

ObjectiveTo investigate the effects of dexmedetomidine and urapidil on postoperative extubation stress response,postoperative shivering,and cerebral oxygen metabolism in patients with hypertensive intracerebral hemorrhage.MethodsA total of 120 patients with hypertensive intracerebral hemorrhage admitted to the Seventh People′s Hospital of Hebei Province from January 2021 to December 2022 were selected as the research subjects.They were randomly divided into an observation group(60 cases)and a control group(60 cases)according to the random number table method.All patients underwent intracranial hematoma removal surgery under general anesthesia combined with bone flap decompression surgery for treatment.The observation group patients received sedation and analgesia with dexmedetomidine and urapidil after surgery,while the control group patients received sedation and analgesia with dexmedetomidine after surgery.The differences in vital signs,stress indicators,cerebral oxygen and cerebral glucose metabolism,and adverse reactions between two groups of patients were compared.ResultsThere was no statistically significant difference in heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),and bispectral index(BIS)between the two groups after entering the room(T_(0))and before anesthesia medication(T_(1))(all P>0.05).The HR,SBP,DBP,and BIS of the observation group were significantly lower than those of the control group at extubation(T_(2)),immediately after extubation(T_(3)),1 minute after extubation(T_(4)),and 3 minutes after extubation(T_(5)),and the differences were statistically significant(all P<0.05).There was no statistically significant difference in various stress indicators between the two groups of patients at T_(0)(all P>0.05),while the stress indicators of the observation group were significantly lower than those of the control group at T_(5)(all P<0.05).There was no statistically significant difference in the cerebral oxygen uptake rate(CERO_(2))and cerebral arteriovenous blood glucose difference(AVDG)between the two groups of patients at T_(0)(all P>0.05),while the CERO_(2) and AVDG in the observation group at T_(5) were significantly higher than those in the control group(all P<0.05).There was no statistically significant difference in the incidence of hypoxemia,hypotension,and bradycardia between the two groups of patients after surgery(all P>0.05).The incidence of postoperative shivering in the observation group was lower than that in the control group(P<0.05).The Glasgow Coma Index of both groups of patients after surgery was higher than that before surgery(all P<0.05),and there was no statistically significant difference in Glasgow Coma Index between the two groups before and after surgery(all P>0.05).ConclusionsDexmedetomidine and Urapidil have significant improvement effects on postoperative extubation stress response,postoperative shivering,and cerebral oxygen metabolism in patients with hypertensive intracerebral hemorrhage.It is recommended to promote them clinically.