右美托咪定对颅内动脉瘤患者围拔管期应激反应和苏醒质量的影响  

Effects of dexmedetomidine to intracranial aneurysms with stress response and awakening quality on tracheal extubation

作　　者：章玲宾[1] 樊理华[1] 卢向红[1] 何仁洪[1] 陈琴[1] 游敏吉[1] 徐巧敏[1] 丁友法[2] 

机构地区：[1]浙江省丽水市人民医院(温州医学院附属第六医院)麻醉科 [2]浙江省丽水市人民医院(温州医学院附属第六医院)检验科

出　　处：《中国临床药理学与治疗学》2013年第10期1144-1147,共4页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：浙江省丽水市重点建设学科科技项目(丽科[2010]57-13)

摘　　要：目的:观察右美托咪定(Dexmedetomidine,Dex)对颅内动脉瘤患者围拔管期应激反应和苏醒质量的影响。方法:选择Hunt/Hess分级为I～II级的施行颅内动脉瘤夹闭术患者50例。随机分成右美托咪定(A组)和生理盐水对照组(B组),每组25例。A组麻醉前10min微泵静脉注射右美托咪定0.5μg/kg,术中0.4μg·kg-1·h-1持续泵注,B组给予等容量的0.9%的氯化钠注射液。两组均采用静吸复合全麻。记录入手术室时(T1)、拔管即刻(T2)、拔管后5min(T3)、10min(T4)的血压(BP)、心率(HR)变化,抽外周静脉血测定皮质醇(COR)、血糖(GLU)、血乳酸(LAC)浓度,并记录麻醉恢复时间,苏醒期躁动评分、拔管后30min视觉模拟(VAS)镇痛评分和Ramsay镇静程度评分。结果:B组的MAP、HR、COR、GLU、LAC较A组增高更为明显(P<0.01或P<0.05);B组苏醒期躁动评分和拔管后30min VAS评分高于A组,而Ramsay镇静程度评分低于A组(P<0.05)。结论:右美托咪定有效抑制了围拔管期的应激反应,能提高麻醉苏醒质量,不延迟苏醒时间。AIM. To observe the effect of dexmedetomidine on intracranial aneurysms with stress response and awakening quality on trache al extubation. METHODS： Select Hunt / Hess grading as I-II-class implementation of intracra nial aneurysm surgery patients 50 cases, and randomly divided into dexmedetomidine group （group A） and normal saline group （group B）, 25 patients in each. Group A were given dexme detomidine with 0.5 μg/kg continuous infusion for 10 min before anesthesia, intraoperative 0.4 μg . kg 1. h 1 continuous infusion. Group B were given the same dose of 0.9G sodium chlo ride injection. Both groups were treated with combined intravenous-inhalation anesthesia. We recorded the changes of blood pressure （BP） and heart rate （HR） at into the operating room （T1） , extubation （T2）, extubation after 5 min （T3）, 10 min （T4）, measured the concentrationof cortisol （COR）, blood glucose （GLU）, blood lactate （LAC）, and recorded anesthesia recovery time, restlessness rating, visual analogue pain scores （VAS） and Ramsay sedation scores after extubation 30 min. RESULTS. The MBP, HR, COR, GLU, LAC of Group B increased more significantly （P%0.01 or P%0.05） than group A. Group B restlessness score and at VAS score 30 minutes after extubation were higher than those of group A, but Ramsay sedation scores were lower in group A （P^0.05）. CONCLU- SION= Dexmedetomidine can effectively inhibit the stress response to tracheal extubation peri- od, can improve the quality of recovery from an- esthesia, do not delay recovery.

关 键 词：颅内动脉瘤 围拔管期 应激反应 苏醒质量 右美托咪定 

分 类 号：R614[医药卫生—麻醉学]