右美托咪啶在高血压脑出血锥颅术全麻中的应用  

Application of Dexmedetomidine in Skull Drilling Operation in General Anesthesia Patients with Hypertensive Intracerebral Hemorrhage

作　　者：曾兆东[1] 程明华[1] 林树勇[1] 庄少惠[1] 

机构地区：[1]广东省汕头大学医学院第一附属医院麻醉科,515041

出　　处：《中华全科医学》2011年第6期862-863,共2页Chinese Journal of General Practice

摘　　要：目的观察右美托咪啶在高血压性脑出血锥颅术静脉麻醉中的应用效果。方法选择60例高血压性脑出血锥颅术患者（脑出血后意识状况分级Ⅲ～Ⅴ级,格拉斯哥昏迷评分GCS≤12分）,ASAⅡ～Ⅳ级,随机分为右美托咪啶＋芬太尼组（D）和异丙酚＋芬太尼组（P）,记录静脉给药即刻（T0）、静脉给药后5 min（T1）、10 min（T2）、15 min（T3）、20 min（T4）、30 min（T5）及手术结束时（T6）的MAP、HR、SpO2和RR;观察患者术中呼吸抑制、肢体扭动发生率。结果两组患者均顺利完成手术,术中D组出现轻度肢体扭动1例（3.3%）,与P组0例比较差异无统计学意义（P〉0.05）;两组患者诱导后及术中D组无呼吸抑制、P组有5例（16.7%）出现呼吸抑制,辅助呼吸后均迅速恢复自主呼吸,面罩供氧下SpO2均保持95%以上。麻醉诱导后两组患者MAP均下降（P〈0.05）,但两组间比较差异无统计学意义（P〉0.05）。麻醉诱导后D组患者HR下降（P〈0.05）,两组间比较差异有统计学意义（P〈0.05）。结论脑出血锥颅术静脉麻醉中右美托咪啶泵注负荷剂量1μg/kg,10 min注完,然后以0.5μg/（kg.h）持续泵注维持,安全性好,无呼吸抑制。Objective To investigate the clinical effect of dexmedetomidine in skull drilling operation in general anesthesia patients with hypertensive intracerebral hemorrhage.Methods We analyzed retrospectively the clinical data of 60 patients with hypertensive intracerebral hemorrhage（Awareness of the situation after cerebral hemorrhage grade Ⅲ-Ⅴ class,GCS≤12 points）.60 patients undergoing cranial drilling pore drainage surgery were randomly divided into dexmedetomidine combined with fentanyl group（Group D） and Propofol combined with fentanyl group（Group P）,each 30 cases.Blood pressure,heart rate and SpO2 were recorded at 0 min,5 min,10 min,15 min,20 min and 30 min after administration and after operation.We recorded adverse reaction and complication after anesthesia.Results The respiratory depression of patients in P group was higher than that in D group（P0.05）.In two groups,MAP after administration were lower than before anesthesia（P0.05）.HR of patients in D group were lower than those in P group（P0.05）.Conclusion The anesthetic effect of dexmedetomidine combined with fentanyl for patients with hypertensive intracerebral hemorrhage undergoing skull drilling operation is satisfactory and has not the potential risk of respiratory inhibition.

关 键 词：右美托咪啶 异丙酚 锥颅术 高血压脑出血 

分 类 号：R743.34[医药卫生—神经病学与精神病学]