不同靶控浓度右美托咪定对开颅动脉瘤夹闭术患者脑氧代谢及脑损伤的影响  

Effects of different target controlled concentrations of dexmedetomidine on cerebral oxygen metabolism and brain injury in patients undergoing intracranial aneurysm clipping

作　　者：牛宣耀[1] 齐丽君 杨中贞 NIU Xuanyao;QI Lijun;YANG Zhongzhen(Department of Anesthesiology,Heze City Hospital,Heze 274000,China)

机构地区：[1]菏泽市立医院麻醉科,山东菏泽274000

出　　处：《麻醉安全与质控》2020年第5期278-282,共5页Perioperative Safety and Quality Assurance

摘　　要：目的探讨右美托咪定对开颅动脉瘤夹闭术患者围术期脑氧代谢、神经损伤标志物以及认知功能的影响。方法选取我院2016-01/2019-10期间接受的60例颅内动脉瘤患者作为研究对象,根据随机数字表法分为高剂量组(n=20)、低剂量组(n=20)、对照组(n=20)。高剂量组和低剂量组分别给予5 ng/mL和3 ng/mL的右美托咪定,对照组给予等量生理盐水,维持该浓度直至手术结束。比较各组麻醉诱导前、手术1 h、手术2 h和手术结束时心率(HR)、平均动脉压(MAP)、动脉颈内静脉球部血氧含量差(Da-jvO2)和脑氧摄取率(CEO2)的差异,比较各组麻醉诱导前、手术结束时以及术后24 h髓鞘碱性蛋白酶(MBP)和神经元特异性烯醇化酶(NSE)的变化,比较各组麻醉诱导前、术后3 d及术后7 d简易智力状态量表(MMSE)评分的变化。结果麻醉诱导前3组的HR、MAP、Da-jvO2、CEO2均无统计学意义(P>0.05),手术1 h、2 h和手术结束时低剂量组与高剂量组的HR、MAP、Da-jvO2、CEO2均明显低于对照组,高剂量组的HR、MAP、Da-jvO2和CEO2均明显低于低剂量组(P<0.05);诱导麻醉前3组的MBP和NSE均无统计学意义(P>0.05),手术结束以及术后24 h时低剂量组与高剂量组的MBP和NSE均明显低于对照组,高剂量组的MBP和NSE均明显低于低剂量组(P<0.05);诱导麻醉前3组的MMSE评分均无统计学意义(P>0.05),术后3 d及术后7 d低剂量组和高剂量组的MMSE评分均明显高于对照组,高剂量组的MMSE评分明显高于低剂量组(P<0.05)。结论动脉瘤夹闭术治疗颅内动脉瘤的过程中使用5 ng/mL的右美托咪定可以改善脑氧代谢,减轻神经功能损伤,改善认知功能。Objective To investigate the effects of dexmedetomidine on perioperative brain oxygen metabolism,neurologic markers and cognitive function in patients undergoing intracranial aneurysm clipping.Methods Altogether 60 patients undergoing intracranial aneurysm clipping,from January 2016 to October 2019,in Heze Municipal Hospital of Shandong Province,were selected and divided into the high-dose group(n=20),the low-dose group(n=20)and the control group(n=20),according to the random number table method and the surgical sequence.The high-dose group and the low-dose group were given 5 ng/mL and 3 ng/mL dexmedetomidine respectively,the control group was given the same amount of normal saline.The concentration was maintained until the end of the operation.Heart rate(HR),mean arterial pressure(MAP),Da-jvO2 and CEO2 were compared before anesthesia,1 h after operation,2 h after operation and at the end of operation.MBP and NSE were compared before anesthesia,at the end of operation and 24 h after operation.MMSE was compared before anesthesia,3 d after anesthesia and 7 d after anesthesia.Results There was no significant difference in HR,MAP,Da-jvO2 and CEO2 among the control group,the low-dose group and the high-dose group before induction of anesthesia(P>0.05).HR,MAP,Da-jvO2 and CEO2 of the low-dose group and the high-dose group were significantly lower than those of the control group at 1 h,2 h after operation and at the end of operation.HR,MAP,Da-jvO2 and CEO2 of the high-dose group were significantly lower than those of the low-dose group(P<0.05).There was no significant difference in MBP and NSE between the control group,the low-dose group and the high-dose group before induction of anesthesia(P>0.05).MBP and NSE in the low-dose group and the high-dose group were significantly lower than those in the control group at the end of operation and 24 h after operation.MBP and NSE in the high-dose group were significantly lower than those in the low-dose group(P<0.05).There was no significant difference in MMSE scores among the c

关 键 词：右美托咪定 颅内动脉瘤 疗效 脑氧代谢 

分 类 号：R614[医药卫生—麻醉学]