右美托咪定对全髋关节置换术患者脑氧代谢与能量代谢的影响  

Effect of dexmedetomidine on cerebral oxygen metabolism and energy metabolism in patients underwent total hip replacement

作　　者：韦秋凤[1] 陈小健[1] 冯丝丝 李想[1] 林成新[1] 

机构地区：[1]广西医科大学第一附属医院麻醉科,南宁530021

出　　处：《广西医科大学学报》2017年第5期743-745,共3页Journal of Guangxi Medical University

摘　　要：目的:研究右美托咪定(Dex)对全髋关节置换术(THP)患者脑氧代谢及能量代谢的影响。方法:选取38例择期全麻下行单侧THP的患者,随机分为Dex组(D组)和对照组(C组),每组19例。D组麻醉诱导后静脉输注Dex负荷量0.5μg/kg(10min),并以0.5μg/kg/h的维持剂量静脉泵注至手术结束(输注时间低于2h),C组在相同时点输入等量生理盐水。在诱导前(T1)、手术开始后40min时(T2)、手术结束时(T3)采集颈静脉球部及桡动脉血分别行血气分析、血糖及血乳酸测定。计算患者动脉血氧含量(CaO2)、颈静脉球部血氧饱和度(SjvO2)、颈内静脉血氧含量(CjvO2)、动—静脉血氧含量(Ca-jvO2)、脑氧摄取率(CERO2)及脑乳酸氧指数(LOI)。结果:两组T2、T3时点的CaO2较T1时点明显下降(P<0.05)。两组T2时点的SjvO2均较T1时点升高,且D组明显高于C组(均P<0.05)。D组T3时点的CjvO2较T1时点明显下降(P<0.05),T2时点的CjvO2较C组明显升高(P<0.05)。两组患者T2、T3时点的Ca-jvO2与T1相比明显下降(P<0.05)。两组T2、T3时点的CERO2均较T1时点明显降低,且D组低于C组(均P<0.05)。两组患者葡萄糖摄取率(GluER)及LOI在组内、组间不同时点比较均差异均无统计学意义(均P>0.05)。结论:Dex能改善THP患者脑氧代谢,维持脑氧供需平衡,对脑能量代谢无不利影响,具有一定的脑保护作用。Objective： To investigate the effects of dexmedetomidine （Dex） on cerebral oxygen metabolism and energy metabolism in patients underwent total hip replacement （THP）. Methods：38 patients underwent unilateral THP surgery with general anesthesia were selected and randomly divided into Dex group and control group, with 19 cases in each group. After anesthesia induction, the patients in Dex group were injected by 0.5 μg/kg Dex for 10 min via intravenous infusion and maintained a dose of 0.5 μg/kg/h until the end of surgery （infusion time 〈2 h）, while those in control group received normal saline. The blood gas analysis, blood glucose and blood lactic acid were detected at pre-anesthesia （T1）, 40 min after surgery （T2） and the end of surgery （T3）. The arterial oxygen content （CaO2）, jugular venous oxygen hemoglobin saturation （SjvO2）, oxygen content of internal jugular vein （CjvO2）, arterial-venous oxygen content difference （Ca-jvO2）, cerebral oxygen extraction rate （CERO2） and lactate-oxygen index （LOI） were calculated. Results： The CaO2at T2 and T3 in both groups were lower than T1 （ P 〈0.05）. The SjvO2 at T2 in both groups were higher than T1, but the difference was more significant in Dex group （ P 〈0.05）. The CjvO2at T3 was lower than T1 in Dex group （ P 〈0.05）, and was higher than that in the control group at T2 （ P 〈0.05）. The Ca-jvO2 and CERO2 at T2 and T3 were lower than those at T1 in both groups, and the CERO2 in Dex group was lower than that in control group （ P 〈0.05）. There were no significant differences in GluER and LOI between the two groups （ P 〉0.05）. Conclusion： Dex could improve cerebral oxygen metabolism, maintain the balance between cerebral oxygen supply and demand, and preserve cerebral energy metabolism in patients underwent THP, which played a protective role on the brain.

关 键 词：右美托咪定 脑氧代谢 脑能量代谢 全髋关节置换术 

分 类 号：R614[医药卫生—麻醉学]