盐酸右美托咪定或丙泊酚复合芬太尼麻醉用于立体定向颅内血肿微创抽吸术治疗高血压脑出血的麻醉效果比较  

Clinical observation of dexmedetomidine versus propofol in combination with fentanyl in sterotactic intracranial haematoma minimally invasive suction treatment for hypertensive cerebral hemorrhage

作　　者：刘玉杰[1] 杜洪印[2] 

机构地区：[1]天津医科大学研究生学院,天津300150 [2]天津医科大学附属第一中心医院麻醉科

出　　处：《上海医学》2012年第12期1001-1004,共4页Shanghai Medical Journal

摘　　要：目的比较盐酸右美托咪定或丙泊酚复合芬太尼麻醉用于立体定向颅内血肿微创抽吸术治疗高血压脑出血的麻醉效果。方法 40例高血压脑出血患者,年龄35～78岁,入院时格拉斯哥昏迷评分(GCS)为6～14分,美国麻醉医师学会分级Ⅱ或Ⅲ级。患者随机分入右美托咪定复合组和丙泊酚复合组,每组20例。患者均先静脉注射芬太尼1μg/kg,之后右美托咪定复合组以2μg·kg-1·h-1剂量经微量静脉输液泵静脉注射右美托咪定15min,丙泊酚复合组经微量静脉输液泵静脉注射丙泊酚6mg·kg-1·h-1,行局部麻醉安放头架,待自主呼吸平稳患者无烦躁可耐受头架后开始手术。右美托咪定复合组以0.5μg·kg-1·h-1的速度静脉注射右美托咪定维持麻醉至手术结束,丙泊酚复合组以3mg·kg-1·h-1的速度静脉注射丙泊酚维持麻醉至手术结束。若出现体动,两组分别追加右美托咪定5μg或丙泊酚20mg,暂停手术5min。比较两组间入手术室和钻孔时及组内安置头架前后的心率、平均动脉压(MAP)、收缩压(SBP)、舒张压(DBP),比较两组间安置支架后和钻孔时的动脉血氧分压(paO2)、动脉血二氧化碳分压(paCO2)。记录围术期不良反应发生情况。结果两组间入手术室时的心率、MAP、SBP、DBP的差异均无统计学意义(P值均>0.05);右美托咪定复合组钻孔时的心率显著慢于丙泊酚复合组(P<0.05),MAP、SBP、DBP均显著高于丙泊酚复合组(P值均<0.05)。右美托咪定复合组组内安置头架前后心率、MAP、SBP、DBP的差异均无统计学意义(P值均>0.05);丙泊酚复合组安置头架后的心率显著快于安置头架前(P<0.05),MAP、SBP、DBP均显著高于安置头架前(P值均<0.05)。右美托咪定复合组安置头架后和钻孔时的paO2显著高于丙泊酚复合组同时间点(P值均<0.05),paCO2显著低于丙泊酚复合组同时间点(P值均<0.05)。右美托咪定复合组术中躁动、低血压、心动过速及术后恶心�Objective To compare the clinical outcomes of dexmedatomidine versus propofol in combination with fentanyl in sterotactic intracranial haematoma minimally invasive suction treatment for hypertensive cerebral hemorrhage. Methods Forty patients with hypertensive cerebral hemorrhage, aged from 35 to 78 years, Glasgrow coma score （GCS） of 6- 14 points and the American Society of Anesthesiologists （ASA） II or III level, were randomly divided into dexmedetomidine group and propofol group （n = 20）. Fentanyl （1 μg/kg） was intravenously injected in all the patients. Then 2 μg·kg-1·h-1h dexrnedetornidine or 6 mg·kg-1·h-1 propofol was slowly infused for 15 mins. Local anesthesia was performed and head frame was put. The surgical treatment began until patients could spontaneously breathe and tolerate head frame. A maintenance dose of dexmedetomidine （0.5 μg·kg-1·h-1） or propofol （3 mg·kg-1·h-1） was continuously infused till the end of the surgery. If body movement appeared, additional dexmedetomidine （5 μg） or propofol （20 mg） was used and the operation suspended for 5 mins. The heart rate （RR）, mean arterial pressure （MAP）, systolic blood pressure （SBP）, diastolic blood pressure （DBP） were recorded before entering operating room, on drilling and before and after the placement of head frame. Arterial partial pressure of oxygen （paO2） and arterial partial pressure of carbon dioxide （paCO2） were also recorded after the placement of head frame and on drilling. Perioperative adverse reactions were observed. Results There were no significant differences in HH, MAP, SBP or DBP between the two groups before entering the operating room （all P〉0. 05）. Compared with propofol group, HH was significantly decreased and MAP, SBP and DBP were significantly increased in dexmedetomidine group on drilling （all P〈0. 05）. There were no significant differences in HH, MAP, SBP and DBP in dexmedetomidine group before and after head frame placement （all P〉0.05）. H

关 键 词：盐酸右美托咪定 芬太尼 颅脑立体定向术 高血压脑出血 

分 类 号：R614[医药卫生—麻醉学]