右美托咪定对颅脑损伤患者全麻下开颅术时的脑保护作用  

Cerebral protection of dexmedetomidine during craniotomy under general anesthesia in patients with craniocerebral injury

作　　者：张韫辉[1] 高金贵[1] 张山[1] 

机构地区：[1]河北医科大学第二医院麻醉科,石家庄市050000

出　　处：《中华麻醉学杂志》2015年第1期30-32,共3页Chinese Journal of Anesthesiology

摘　　要：目的 评价右美托咪定对颅脑损伤患者全麻下开颅术时的脑保护作用.方法 拟在全麻下行开颅术的颅脑损伤患者60例,性别不限,年龄30～50岁,体重指数18～25 kg/m^2,ASA分级Ⅱ或Ⅲ级,格拉斯哥昏迷计分法评分6～12分,采用随机数字表法,将其分为2组（n=30）：对照组（C组）和右美托咪定组（Dex组）.Dex组于常规麻醉诱导用药前经10 min静脉输注右美托咪定1 μg/kg,随后以0.5 μg· kg^-1·h^-1输注至术毕,C组给予等容量生理盐水.于手术开始前即刻（T0）、切开硬脑膜即刻（T1）、手术开始后2h（T2）、缝合硬脑膜（T3）和手术结束（T4）时采集桡动脉和颈内静脉球部血样,进行血气分析,计算动脉-静脉血氧含量差和脑氧摄取率;采用ELISA法测定血清S-100β蛋白浓度.结果 与T0时比较,2组T2-4时血清S-100β蛋白浓度升高（P＜0.05）;与C组比较,Dex组T2-4时血清S-100β蛋白浓度降低（P＜0.05）;2组脑氧代谢指标均在正常范围.结论 常规麻醉诱导前静脉输注右美托眯定1 μg/kg,随后以0.5 μg·kg^-1 h^-1输注至术毕对颅脑损伤患者全麻下开颅术时产生一定的脑保护作用.Objective To evaluate the cerebral protection of dexmedetomidine during craniotomy under general anesthesia in the patients with craniocerebral injury.Methods Sixty patients with craniocerebral injury,aged 30-50 yr,with body mass index of 18-25 kg/m^2,of ASA physical status Ⅱ or Ⅲ,with Glasgow Coma Scale score of 6-12,scheduled for elective craniotomy under general anesthesia,were randomized into 2 groups （n =30 each） using a random number table：control group （group C） and dexmedetomidine group （group Dex）.Anesthesia was induced with iv midazolam,propofol,cisatracurium and sufentanil.The patients were endotracheally intubated and mechanically ventilated.In group Dex,dexmedetomidine 1 μg/kg was infused intravenously over 10 min before induction of anesthesia,followed by infusion at a rate of 0.5 μg · kg^-1 · h^-1 until the end of operation.The equal volume of normal saline was given in group C.Immediately before beginning of surgery （T0）,at the moment when the duramater was opened （T1）,at 2 h after beginning of surgery （T2）,at the duramater closing （T3） and at the end of surgery （T4）,blood samples were obtained from the radial artery and jugular venous bulb for blood gas analysis,arteriovenous blood O2 difference and cerebral O2 extraction rate were calculated.The serum concentrations of S-100β were measured by ELISA.Results The serum concentrations of S-100β were significantly increased at T2-4 than at T0 in both groups.The serum concentrations of S-100β were significantly decreased at T2-4 in group Dex than in group C.The parameters of cerebral oxygen metabolism were all within the normal range in both groups.Conclusion Dexmedetomidine （1 μg/kg infused intravenously before induction of anesthesia,followed by infusion at a rate of 0.5 μg · kg^-1 · h^-1 until the end of operation） provides cerebral protection to some extent during craniotomy under general anesthesia in the patients with craniocerebral injury.

关 键 词：右美托眯啶 颅脑损伤 麻醉 全身 

分 类 号：R614[医药卫生—麻醉学]