右美托咪啶辅助丙泊酚靶控输注在颅内动脉瘤介入栓塞中的麻醉效果  

Anesthetic Effect of Dexmedetomidine Assistant Propofol Target-controlled Infusion on Patients with Intracranial Aneurysm Interventional Embolization

作　　者：李坤[1] 牛金柱[1] 王献章[2] 刘明[1] 兰海涛[1] 李艳朔[1] 

机构地区：[1]解放军264医院麻醉科,太原030001 [2]解放军264医院军人诊疗中心,太原030001

出　　处：《解放军医药杂志》2014年第1期73-77,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

摘　　要：目的 探讨右美托咪啶（dexmedetomodine,DEX）辅助丙泊酚靶控输注用于颅内动脉瘤介入栓塞手术患者的麻醉效果.方法 选择2011年8月-2013年2月择期行颅内动脉瘤介入栓塞手术患者60例,随机分为观察组和对照组,每组30例.患者均未用术前药,观察组在麻醉诱导前15 min静脉泵注DEX,然后以0.4 μg/（kg·h）速度持续静脉泵注至手术结束前20 min,对照组静脉注射等量的0.9%氯化钠注射液.麻醉诱导：两组均依次静脉注射咪达唑仑、芬太尼、丙泊酚、顺阿曲库铵,插管后行机械通气.麻醉维持：靶控输注丙泊酚,根据麻醉深度和血流动力学变化调节丙泊酚靶控浓度,静脉输注芬太尼、顺阿曲库铵.记录两组麻醉诱导前15 min（T0）、麻醉诱导前（T1）、插管前（T2）、插管后即刻（T3）、介入栓塞时（T4）、拔管即刻（T5）、拔管后5 min（T6）的平均动脉压（MAP）、心率、血氧饱和度（SpO2）及脑电双频指数（BIS）;记录气管导管拔除时间和清醒时间、麻醉药总使用量、血管活性药物使用次数,不良反应发生率及术后24 h随访情况.结果 两组手术、拔管和清醒时间,以及芬太尼、顺阿曲库铵用量比较差异无统计学意义（P〉0.05）;观察组丙泊酚总使用量少于对照组,麻黄碱、艾司洛尔、硝酸甘油使用率均低于对照组,阿托品使用率高于对照组（P〈0.05）.对照组MAP及BIS在T2~4时点、心率在T2时点均低于T0,而在T5、T6时点MAP及心率均高于T0（P〈0.05）.观察组MAP在T1时点高于T0,T2~4时点高于对照组,T5、T6时点低于对照组,心率在T1~4时点低于T0,在T1~6时点低于对照组,BIS在T1~4时点均低于T0和对照组（P〈0.05）.观察组围麻醉期不良反应发生率均低于对照组（P〈0.05）.两组无术中知晓发生.结论 DEX辅助丙泊酚靶控输注用于颅内动脉瘤介入栓塞手术患者的麻醉可使围麻醉期血流动力学平稳,不良反应发生率降�Objective To explore the anesthetic etlect of Dexmedetomidine （DEX） assistant Propotoi targetcontrolled infusion （TCI） on patients with intracranial aneurysm interventional embolization. Methods Sixty patients undergoing selective operations with intracranial aneurysm interventional embolization during August 2011 and February 2013 were divided into observation group （n = 30） and control group （n = 30）. All the patients had no premedicant, and the observation group underwent intravenous infusion DEX 15 minutes before anesthesia induction, and then was given continuous intravenous infusion at a rate of 0. 4 μg/ （kg · h） until 20 minutes before the operation was finished; while the control group was given the same volum of 0.9% sodium chloride injection. Anesthetic inductions of the two groups were given with intravenous injection of Midazolam, Fentanyl, Propofol and Cisatracurium one after another, and mechanical ventilation was performed after intubation. Anesthesia maintenance was obtained by using TCI Propofol, and the target concentration of Propofol was adjusted based on anesthetic depth and hemodynamic changes, and then Fentanyl and Cisatracurium were intravenously infused. The mean arterial pressure （MAP） , heart rate （HR） , arterial oxygen saturation （SpO2） and bispectral index （BIS） of two groups were recorded 15 minutes before anesthesia induction （T0） , before anesthetic induction （T1 ） , before intubation （T2）, the moment of intubation （T3）, interventional embolism （T4）, the moment of extubation （T5） and 5 minutes after extubation （T6）. The extubation time, conscious recovery time, the total dosage of the anesthetic, the frequency of vasoactive drug use, incidence rate of adverse reactions and status of 24 h follow-up were also recorded. Results The differences in times of operation, extubation and conscious recovery, and doses of Fentanyl and Cisatracurium between the two groups showed no statistical significance （P 〉 0. 05）; Comp

关 键 词：右美托咪啶 异丙酚 麻醉药 静脉 颅内动脉瘤 栓塞 治疗性 

分 类 号：R614.24[医药卫生—麻醉学]