右美托咪定对脑外伤和非脑外伤患者脑血流、脑氧代谢的影响  

Influence of dexmedetomidine on cerebral blood flow and cerebral metabolic rate in patients with or without traumatic brain injury

作　　者：季君慧[1] 范晴敏 移小峰[1] JI Jun-hui(Department of anesthesiology,the first hospital affiliated to Suzhou University,Suzhou,Jiangsu,215000,China.)

机构地区：[1]苏州大学附属第一医院麻醉科,江苏苏州215000 [2]苏州大学附属第一医院超声科,江苏苏州215000

出　　处：《齐齐哈尔医学院学报》2019年第21期2664-2666,共3页Journal of Qiqihar Medical University

摘　　要：目的比较右美托咪定(Dex)对脑外伤患者及非脑外伤患者脑血流及脑氧代谢的影响。方法选择2018年1—12月本院重症监护室(ICU)收治的非脑外伤患者(CON组,20例)和格拉斯哥昏迷(GCS)评分为9~12分的脑外伤患者(TBI组,20例)作为研究对象,所有患者静脉注射负荷剂量Dex 1μg/kg(输注时间10 min)后以0.4μg kg-1 h-1维持1 h,同时以多巴胺维持患者血压于用药前水平。采集相关数据计算Dex用药前、用药70 min时脑血流量(CBF)和脑氧代谢率(CMR)。结果与用药前相比,CON组患者用药70 min时CBF明显降低(P<0.01),而CMR无明显改变(P>0.05)。TBI组患者用药前后CBF和CMR均无明显改变(P>0.05)。结论维持体循环血压的前提下,Dex减少非脑外伤患者CBF,但对TBI患者CBF及两组患者CMR均无明显影响,Dex减少CBF主要与其收缩脑血管有关。Objective To observe the different effects of dexmedetomidine on cerebral blood flow(CBF)and cerebral metabolic rate(CMR)in patients with or without traumatic brain injury(TBI).Methods Twenty patients without TBI(CON group)and twenty patients with TBI with a Glasgow Coma Scale score between 9 and 12(TBI group)were enrolled in this study.All patients received 1μg/kg dexmedetomidine infused over 10 minutes,followed by 0.4μg/kg/h continuous infusion for 60 minutes.Blood pressure was maintained at the pre-sedation level by using dopamine for all patients.The CBF and CMR were measured before sedation and 70 minutes after administration of dexmedetomidine.Results Dexmedetomidine administration significantly decreased CBF in patients of the CON group(P<0.01),but without altering the CMR(P>0.05).The dexmedetomidine-induced change of CBF and CMR was not significant in the TBI group(P>0.05).Conclusions Under the premise of maintaining systemic circulatory blood pressure,dexmedetomidine reduces CBF in patients without brain injury,but there is no significant effect on CBF in TBI patients and CMR in both groups.Reduction of CBF was mainly related to the contraction of brain blood vessels induced by dexmedetomidine.

关 键 词：右美托咪定 脑血流量 脑氧代谢率 多普勒超声 

分 类 号：R614.2[医药卫生—麻醉学]