盐酸右美托咪定对颅内动脉瘤夹闭术患者血流动力学及脑氧代谢的影响  

The influence of dexmedetomidine hydrochloride on hemodynamics and cerebral oxygen metabolism of the patients with intracranial aneurysm clipping

作　　者：柏晓漫[1] 梁枫[1] 李龙云[1] 陈鹏[1] 

机构地区：[1]吉林大学中日联谊医院麻醉科,吉林长春130033

出　　处：《中国实验诊断学》2013年第7期1200-1202,共3页Chinese Journal of Laboratory Diagnosis

摘　　要：目的评价盐酸右美托咪定对颅内动脉瘤夹闭术患者血流动力学及脑氧代谢的影响。方法全麻下行颅内动脉瘤夹闭术患者60例,ASA分级Ⅰ或Ⅱ级。采用随机数字表法,将其随机分为2组.每组30例。Ⅰ组病人单次输注右美托咪定1μg/kg,输注时间10min,然后改为维持输注0.5μg/kg.hr,Ⅱ组病人输注等量生理盐水。单次输注结束后依次静脉注射咪达唑仑2mg、异丙酚2mg/kg、舒芬太尼0.5μg/kg、维库溴铵0.1mg/kg诱导,插入气管导管,控制呼吸。全静脉维持麻醉维持深度,使脑电双频谱指数(BIS)维持在40-50之间。桡动脉穿刺监测有创血压,患者颈内静脉球穿刺以备采血。记录术前(T1)、插管即刻(T2)、插管后3min(T3)、5min(T4)、瘤体分离完成(T5)、夹闭即刻(T6)、夹闭后30min(T7)7个时点血压、心率。在T5、T6、T7 3个时点桡动脉及颈内静脉球血气分析,记录动脉血氧分压(PaO2)、颈内静脉球血氧分压(PjvO2)、动脉血氧饱和度(SaO2)、颈内静脉球血氧饱和度(SjvO2)、动脉血红蛋白浓度(Hb)、颈内静脉球血红蛋白浓(Hjvb)。计算桡动脉与颈内静脉球氧含量差和结果:Ⅱ组病人在T2、T3、T4时点BP、HR较Ⅰ组病人明显升高(P<0.05);Ⅰ组病人在T5、T6、T7 3个时点Da-jvO2、较Ⅱ组病人明显升高、Sj-vO2明显减低(P<0.05)。结论盐酸右美托咪定用于颅内动脉瘤夹闭术患者可稳定围术期血流动力学,提高脑氧摄取率,改善脑氧合。Objective Evaluate the influence of Dexmedetomidine Hydrochloride on hemodynamics and cerebral oxy- gen metabolism of the patients with intracrania[ aneurysm clipping. Methods There are sixty cases of patients with the general anesthesia undergoing intracranial aneurysm clipping,and ASA classification is I or ]] level. Adopt the method of the table of random number,and divide them into two groups randomly,wlth 30 cases in each group. The patients of Group I infuse Dexmedetomidine Hydrochloride 1 ~g/kg one time,and the infusion time is 10 minutes,then change to maintain the infusion as 0.5/~g/kg. hr. The patients of Group U infuse equal amount of physiological saline. After com- pleting the infusion,intravenous inject Midazolam 2 rag, propofol 2 mg/kg, sufentanil 0.5 /~g/kg, vecuronium bromide 0.1 mg/kg in turn to induce. Insert the tracheostomy tube,and control the breath. Maintain the depth of anesthesia with total intravenous anesthesia. Make the BISmaintain between 40 and 50. Monitor the invasive blood pressure with radial artery puncture. Puncture the jugular venous bulb of patients to prepare for the blood sampling. Record the blood pres- sure and heart rate of seven time points,preoperative （T1） ,the immediate time of intubation （T2） ,3 minutes after intu- bation （T3）,5 minutes after intubation （T4）,the time completing the separation of tumor body （TS）,the immediate time of occlusion （T6） ,30 minutes after occlusion （T7）. Carry on the blood gas analysis of radial artery and jugular ve- nous bulb at T~ ,T6 ,T7 three time points. Record the arterial partial pressure of oxygen （PaO2） ,the partial pressure of oxygen of jugular venous bulb （PjvO2）, arterial oxygen saturation （SAG2）, the blood oxygen saturation of jugular ve- nous bulb （SjvO3）, arterial hemoglobin concentration （Hb）, the hemoglobin concentration of jugular venous bulb （Hjvb）. Calculate the difference of oxygen content of radial artery and jugular venous bulb,and the cerebral extraction of oxygen

关 键 词：盐酸右美托咪定 血流动力学参数 脑氧代谢 

分 类 号：R614[医药卫生—麻醉学]