右美托咪定用于减轻颅内动脉瘤患者麻醉诱导期血流动力学波动的临床价值  

Clinical value of attenuating hemodynamic fluctuation in patients with cerebral aneurysm during anesthesia induction

作　　者：李博[1] 陈辉[1] 张冉[1] 李斌本[1] 范晓华[1] 侯炯[1] 

机构地区：[1]第二军医大学第一附属医院麻醉科,上海200433

出　　处：《中国医师进修杂志》2012年第12期1-3,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨右美托咪定在颅内动脉瘤介入手术全身麻醉诱导期减少血流动力学波动中的应用。方法选择全身麻醉下行颅内动脉瘤介入手术的患者60例，采用随机数字表法分为低剂量芬太尼组、高剂量芬太尼组和低剂量芬太尼复合右美托咪定组（复合组），每组20例。麻醉诱导前，复合组经微量泵持续静脉注射右美托咪定，总量1恤g／kg，泵注时间10min；低剂量芬太尼组和高剂量芬太尼组注射等量0．9％氯化钠。麻醉诱导时，低剂量芬太尼组和复合组静脉注射芬太尼3μs／ks、高剂量芬太尼组静脉注射芬太尼5μs／ks，余用药相同。记录入手术室平静休息3min（T0）、气管内插管前即刻（T1）、插管后即刻（T2）、插管后3min（T3）的收缩压（SBP）、舒张压（DBP）、心率（HR）。将每例患者麻醉诱导期间（T0-T3）SBP、DBP、HR最大值与最小值之差定义为各参数的波动值：△SBP、ADBP、AHR。记录诱导期间麻黄碱、阿托品的使用情况。结果复合组ASBP、△DBP、AHR[（26．9±14．8）mmHg（1mmHg=0．133kPa）、（10．7±8．9）mmHg、（12．5±4．3）次／min]均低于低剂量芬太尼组[（40．4±15．6）mmHg、（20．3±9．4）mmHg、（30．1±15．0）次／min]（P〈0．05），高剂量芬太尼组△SBP、△HR[（29．8±16．8）mmHg、（19．5±7．4）次／min]均低于低剂量芬太尼组（P〈0．05），复合组AHR低于高剂量芬太尼组（P〈0．05）。麻醉诱导期三组阿托品使用率比较差异无统计学意义（P=0．364），高剂量芬太尼组麻黄碱使用率高于低剂量芬太尼组[30％（6／20）比5％（1／20），P=0．03230结论麻醉诱导前应用1μg/kg右美托咪定，既能够良好抑制插管反应，又不会导致插管后血压严重下降，达到了稳定血流动力学的目标，特别适用于颅内动脉瘤患者的麻醉诱导。Objective To investigate the application of dexmedetomidine attenuating hemodynamic fluctuation in patients with cerebral aneurysm during anesthesia induction. Methods Sixty patients undergoing elective interventional procedure with cerebral aneurysm were divided into low dose of fentanyl group （group LF）, high dose of fentanyl group （group HF）, and low dose of fentanyl and dexmedetomidine combination group （group FD） by random digits table method with 20 cases each. Before induction of anesthesia, the patients in group FD received dexmedetomidine 1μg/kg for 10 minutes, and the others received 0.9% sodium chloride with the same volume. During anesthesia induction, fentanyl 3 μg/kg in group LF and group FD, and fentanyl 5 μg/kg in group HF. Other anesthetics were equalized. Systolic blood pressure （SBP）, diastolic blood pressure （DBP） and heart rate （HR） were monitored and recorded at 3 min utes after lying on table （To）, before intubation （TI）, immediately and 3 min utes after intubafion （T2,T3）. The differences between the maximum and the minimum of SBP, DBP and HR were calculated in these time points as fluctuation values, named as A SBP, A DBP and A HR. Results A SBP, A DBP and A HR in group FD [（26.9 ± 14.8） mm Hg（1 mm Hg =0.133 kPa）, （10.7 ±8.9） mm Hg, （12.5 ±4.3） times/mini were lower than those in group LF [ （40.4 ± 15.6） mm Hg, （20.3 ± 9.4） mm Hg, （ 30.1 ± 15.0） times/min ] （P 〈 0.05 ）, as well as A SBP and A HR in group HF [ （29.8 ± 16.8 ） mra Hg, （19.5 ± 7.4） times/min ] were lower than those in group LF （P 〈 0.05）. While A HR in group FD was lower than that in group HF （P 〈 0.05 ）. The usage of atropin in three group had no statistical significance during anesthesia induction （P = 0.364） ,but more ephedrine was used in group HF than in group LF [30%（6/20） vs. 5%（1/20） ,P = 0.032]. Conclusion Dexmedetomidine 1μg/kg injected before anesthesia induction , which could prevent intubation reactio

关 键 词：颅内动脉瘤 麻醉 血流动力学 

分 类 号：R614[医药卫生—麻醉学]