右美托咪定滴鼻对颅内动脉瘤介入治疗全麻拔管期血流动力学的影响  

Effects of intranasal dexmedetomidine on hemodynamics during extubation under general anesthesia in patients with mintracranial aneurysm undergoing interventional therapy

作　　者：李敏[1] 刘志贵[1] 石泉[1] 熊威威[1] 梁维[1] 陈治军[1] LI Min;LIU Zhi-gui;SHI Quan;XIONG Wei-wei;LIANG Wei;CHEN Zhi-jun(Department of Anesthesiology,Affiliated Hospital of Guilin Medical College,Guilin 541001,China)

机构地区：[1]桂林医学院附属医院麻醉科,广西桂林541001

出　　处：《中国临床神经外科杂志》2019年第2期87-89,92,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的观察右美托咪定滴鼻对颅内动脉瘤介入治疗全麻拔管期血流动力学的影响。方法选择择期行介入治疗的颅内动脉瘤80例,根据滴鼻药物分为4组(n=20),即对照组(C组)和低、中、高剂量右美托咪定组(D1组、D2组、D3组)。手术结束前30 min,D1、D2、D3组用右美托咪定0.6、1.0、1.4μg/kg滴鼻,C组用生理盐水滴鼻。记录入室时(T0)、滴鼻前即刻(T1)、手术结束时(T2)、患者苏醒时(T3)、拔管时(T4)、拔管后1 min(T5)、5 min(T6)心率(HR)、平均动脉压(MAP)、收缩压与心率的乘积(RPP);记录术后恢复指标(包括苏醒时间、拔管时间、拔管质量评分、Ramsay镇静评分)。结果与C组比较,D1组T3～T5、D2和D3组T2～T6 MAP、RPP、HR均明显降低(P<0.05);D2组和D3组拔管质量评分均明显降低(P<0.05)、Ramsay评分均明显增高(P<0.05),D3组苏醒时间及拔管时间均明显延长(P<0.05)。与D1组比较,D2和D3组T3～T6 MAP、RPP、HR均明显降低(P<0.05),D3组拔管质量评分明显降低(P<0.05)、RamaSay比较,D3组苏醒时间及拔管时间均明显延长(P<0.05)。D2和D3组HR、MAP、RPP、拔管质量评分、Ramsay镇静评分均无统计学差异(P>0.05)。结论手术结束前30 min给予右美托咪定1.0μg/kg滴鼻全麻拔管期血流动力学平稳,同时不影响术后恢复。Objective To observe the effects of intranasal dexmedetomidine on hemodynamics during the extubation under the general anesthesia in the patients with intracranial aneurysm undergoing interventional therapy.Methods Eighty patients with intracranial aneurysm undergoing interventional treatment were divided into four groups of 20 patients each,i.e.,control group(C group)and nasal drops with different doses of dexmedetomidine(D1,D2 and D3 groups).The patient in D1,D2 and D3 groups was treated by intranasal 0.6,1.0 and 1.4μg/kg dexmedetomidine,respectively,and the patient in C group was treated by intranasal isovalumic physiologial saline 30 minutes before the end of the operation.The heart rate(HR),mean arterial pressure(MAP)and real protfollo project(RPP)were recorded on admission to the operating room(T0),immediately before the nasal drip(T1),the finishing operation(T2),at revival(T3),at extubation(T4),and 1(T5)and 5 minutes(T6)after the extubation.The indexes of postoperative recovery were recorded.Results The HR,MAP and RPP at T3~T5 in D1 group and at T2~T6 in D2 and D3 group were significantly lower than those in C group(P<0.05).The time of recovery from the anesthetic condition and duration of intubating were significantly shorter in C,D1 and D2 groups than those in D3 group(P<0.05).Conclusions The intranasal 1.0μg/kg dexmedetomidine 30 minutes before the end of the operation is helpful to the stabilization of the hemodynamics in peri-extubation period and postoperative recovery in the patients with intracranial aneurysm undergoing interventional therapy.

关 键 词：颅内动脉瘤 血管内栓塞 右美托咪定 滴鼻 拔管期 血流动力学 

分 类 号：R743.9[医药卫生—神经病学与精神病学] R815.2[医药卫生—临床医学]