右美托咪定对大脑动脉瘤介入栓塞术患者气管拔管反应的影响  

The effect of dexmedetomidine on tracheal extubation in patients with cerebral aneurysm embolization

作　　者：唐建成[1] 黄焕森[1] 徐世元[2] TANG Jian- cheng;HUANG Huan -sen;XU Shi -yuan.(Department of Anesthesiology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, Guangdong, China)

机构地区：[1]广州医科大学附属第二医院麻醉科,广东广州510260 [2]南方医科大学珠江医院麻醉科,广东广州510280

出　　处：《广东医学》2018年第9期1291-1293,共3页Guangdong Medical Journal

摘　　要：目的评价右美托咪定对大脑中动脉瘤栓塞术患者苏醒阶段气管拔管反应的保护效果。方法将ASA分级Ⅰ~Ⅱ级大脑中动脉介入栓塞术患者60例随机分为2组,D组:气管插管前给予右美托咪定负荷量为1μg/kg(10 min),插管后泵注量为0.5μg/(kg·h)至适当时机停药;C组:相同剂量的生理盐水取代右美托咪定。两组患者应用丙泊酚[5~8 mg/(kg·h)]、瑞芬太尼[10~15μg/(kg·h)]和维库溴铵[0.08~0.1 mg/(kg·h)]维持适当麻醉深度。采集患者生命体征:平均动脉压(MAP)、心率(HR)、脑电双频指数(BIS)值及麻醉药物用量、苏醒时间、拔管时间和质量评分、躁动评分。结果 D组拔管时MAP、HR和拔管质量评分及躁动评分显著低于C组(P<0.05);D组苏醒和拔管时间明显短于C组(P<0.05);D组镇静和镇痛药物用量明显比C组少(P<0.05)。结论右美托咪定可以改善大脑中动脉瘤介入栓塞术患者气管拔管时血流动力学改变、降低其发生呛咳和躁动的可能性,可以有效地预防大脑中动脉瘤介入栓塞术后患者再出血风险。Objective To investigate the effect of dexmedetomidine on stress response to tracheal extubation in patients with brain aneurysm embolization. Methods Sixty patients（ ASA Ⅰ-Ⅱ）,who received neurosurgery,were randomly divided into Group D and control group（ Group C）. The patients in Group D received dexmedetomidine [preload of 1 μg/kg and constant infusion of 0. 5 μg/（ kg·h） ]. The patients in Group C received equivalent volume physiological saline. All patients received propofol [5-8 mg/（ kg·h） ],remifentanil [10-15 μg/（ kg·h） ] and vecunrium[0. 08-0. 1 mg/（ kg·h） ] to maintain reasonable level of anesthesia during the operation. The mean arterial pressure（ MAP） and heart rate（ HR） were recorded before extubation,at extubation,1 min and 15 min after extubation. The extubation quality scores,postoperative sedation scores,extubation and awakening times,total dosage of narcotic drugs were also recorded and evaluated. Results The MAP and HR were significantly increased at extubation compared with before extubation in two groups（ P〈 0. 05）. At extubation,1 min and 15 min after extubation,the MAP and HR were significantly lower in Group D than Group C（ P〈 0. 05）. The extubation quality score,postoperative sedation score,extubation and awakening times,and incidence of sore throat within 24 h after operation were significantly lower in Group D than Group C（ P〈 0. 05）. Conclusion Dexmedetomidine can attenuate the stress response of tracheal extubation in the patients with brain aneurysm embolization,thus can prevent rebleeding.

关 键 词：右美托咪定 介入栓塞术 气管拔管反应 

分 类 号：R614[医药卫生—麻醉学]