麻醉诱导期应用小剂量右美托咪定在颅内动脉瘤患者中的临床研究

Clinical trial of low dose dexmedetomidine in the treatment of patients with intracranial aneurysm during anesthesia induction

目的观察小剂量右美托咪定用于在麻醉诱导期对颅内动脉瘤患者术后稳定的临床疗效和安全性。方法将行颅内动脉瘤血管夹闭术+颅内压探头置入术治疗的颅内动脉瘤患者按队列法分为试验组和对照组。对照组患者在麻醉诱导开始前经静脉给予咪达唑仑注射液0.1 mg·kg^(-1)、注射用顺阿曲库铵0.15 mg·kg^(-1)完成麻醉诱导,插入气管导管,观察患者的呼吸情况。试验组患者于麻醉诱导前15 min至手术结束期间予以盐酸右美托咪定注射液0.4μg·kg^(-1)·h^(-1)静脉泵注,其余用药同对照组。对比2组患者麻醉诱导前(T1)、麻醉诱导完成即刻(T2)、气管插管时(T3)、夹闭动脉瘤时(T4)、术毕(T5)、拔管后2 min(T6)的血流动力学指标,镇静质量与苏醒评分,颅内压波形参数,并进行安全性评价。结果对照组和试验组均入组40例患者。试验组和对照组T6时的心率(HR)分别为(82.31±9.73)和(86.91±10.36)beat·min^(-1),镇静-躁动评分(SAS)分别为(3.22±0.75)和(3.58±0.80)分,术后第1天的平均颅内压波幅(MWA)分别为(3.42±0.75)和(3.76±0.69)mmHg,术后第2天MWA分别为(2.68±0.63)和(2.98±0.57)mmHg,术后第1天压力波幅相关性指数(RAP)分别为0.46±0.11和0.52±0.12,试验组的上述指标与对照组比较,在统计学上差异均有统计学意义(均P<0.05)。试验组和对照组术中瑞姆赛镇静评分(Ramsay)、麻醉苏醒时间、术后6 h疼痛视觉模拟评分(VAS)比较,在统计学上差异均无统计学意义(均P>0.05)。试验组和对照组唤醒期间的总药物不良反应发生率分别为25.00%(10例/40例)和36.84%(14例/38例),在统计学上差异无统计学意义(P>0.05)。结论小剂量盐酸右美托咪定注射液应用在麻醉诱导期,可稳定颅内动脉瘤术后颅内压波形参数、血压、心率、呼吸频率等。

Objective To observe the clinical efficacy and safety of low dose dexmedetomidine for postoperative stability in patients with intracranial aneurysm during anesthesia induction.Method Patients with intracranial aneurysms treated with intracranial aneurysm clipping+intracranial pressure probe implantation were divided into treatment group and control group by cohort method.The patients in the control group were given intravenous midazolam injection 0.1 mg·kg^(-1)and cisatracurium 0.15 mg·kg^(-1)before the start of anesthesia induction to complete the anesthesia induction,and the endotracheal tube was inserted to observe the patient's breathing.Patients in the treatment group were given intravenous infusion of dexmedetomidine hydrochloride injection 0.4μg·kg^(-1)·h^(-1)from 15 min before anesthesia induction to the end of surgery;and the other drugs were the same as those in the control group.The hemodynamic indexes,sedation quality and recovery score,intracranial pressure waveform parameters were compared between the two groups before anesthesia induction(T1),immediately after anesthesia induction(T2),at tracheal intubation(T3),at aneurysm clipping(T4),at the end of operation(T5)and 2 min after extubation(T6),and the safety was evaluated.Results The control group and the treatment group were enrolled in 40 patients.The heart rate(HR)at T6 in the treatment group and the control group were(82.31±9.73)and(86.91±10.36)beat·min^(-1),respectively;the sedation-agitation scale(SAS)were3.22±0.75 and 3.58±0.80,respectively;the mean waveform amplitude(MWA)on the first day after operation were(3.42±0.75)and(3.76±0.69)mmHg,respectively;the MWA on the second day after operation were(2.68±0.63)and(2.98±0.57)mmHg,respectively;the relationship of amplitude and pressure(RAP)on the first day after operation were 0.46±0.11 and 0.52±0.12,respectively.The above indexes in the treatment group were significantly different from those in the control group(all P<0.05).There was no significant difference in Ramsay sedation score(Ramsay),anesthesia recovery time and visual analogue scale(VAS)score at 6 h after operation between the treatment group and the control group(all P>0.05).The total incidence of adverse drug reactions during the wake-up period in the treatment group and the control group was 25.00%(10 cases/40 cases)and 36.84%(14 cases/38 cases),respectively,with no statistically significant difference(P>0.05).Conclusion The application of low-dose dexmedetomidine hydrochloride injection in the induction period of anesthesia can stabilize the intracranial pressure waveform parameters,blood pressure,heart rate,respiratory rate,etc.after intracranial aneurysm surgery.