右美托咪定对七氟醚麻醉下行微创手术治疗腰椎骨折患者动态脑自动调节功能及CO2反应性影响  

Effects of dexmedetomidine on dynamic cerebral autoregulation and carbon dioxide reactivity in minimally invasive surgery for lumbar spine fracture under sevoflurane anesthesia

作　　者：陈敏[1] 黄华溢[2] 叶方斌[3] 何博[1] CHEN Min;HUANG Hua-yi;YE Fang-bin;HE Bo(Department of Anesthesiology,Hubei Aerospace Hospital,Xiaogan 432000,China)

机构地区：[1]湖北航天医院麻醉科,湖北孝感432000 [2]湖北航天医院骨科,湖北孝感432000 [3]湖北航天医院神经内科,湖北孝感432000

出　　处：《创伤与急危重病医学》2021年第1期45-49,共5页Trauma and Critical Care Medicine

摘　　要：目的探讨右美托咪定对七氟醚麻醉下行微创手术治疗的腰椎骨折患者动态脑自动调节功能及CO2反应性的影响。方法选取自2015年1月至2020年1月于湖北航天医院行微创手术治疗的62例腰椎骨折患者为研究对象,根据应用右美托咪定的情况分为A组(n=20)、B组(n=21)与C组(n=21)。A组不给予右美托咪定;B组给予小剂量右美托咪定,负荷剂量0.5μg/kg,维持剂量0.2μg/(kg·h);C组给予大剂量右美托咪定,负荷剂量1.0μg/kg,维持剂量0.4μg/(kg·h)。记录并比较3组患者围术期指标(术后恢复时间、拔管时间、总芬太尼使用量、总丙泊酚使用量、总维库溴铵使用量、静脉输液量、失血量、手术时间、麻醉时间、改良Aldrete评分)、大脑中动脉血流速度(MCAFV)、心率(HR)、平均动脉压(MAP)、二氧化碳分压(PaCO2)、短暂性充血反应比值(THRR)、测量颈动脉压迫期间血流速度下降幅度的压缩率(CR)、绝对CO2反应性、相对CO2反应性、搏动指数。结果C组患者总芬太尼使用量、总维库溴铵使用量、失血量均低于A组、B组,差异有统计学意义(P<0.05)。3组患者THRR、CR、绝对CO2反应性、相对CO2反应性、搏动指数比较,差异均无统计学意义(P>0.05)。3组患者通气前、通气后HR、MAP、PaCO2、MCAFV比较,差异均无统计学意义(P>0.05)。结论以临床规定剂量给予右美托咪定不易影响七氟醚麻醉下行微创手术治疗的腰椎骨折患者动态脑自动调节功能及CO2反应性。Objective To investigate the effects of dexmedetomidine on dynamic cerebral autoregulation and carbon dioxide(CO2)reactivity in patients with lumbar spine fracture who undergoing minimally invasive spinal trauma surgery under sevoflurane anesthesia.Methods A retrospective study was performed on 62 cases of patients with lumbar spine fracture who were admitted and underwent minimally invasive spinal trauma surgery from January 2015 to January 2020.According to the different uses of dexmedetomidine,the patients were divided into Group A(n=20),Group B(n=21)and Group C(n=21).Patients of Group A were not given dexmedetomidine;Group B of patients were given small dose of dexmedetomidine,with loading dose of 0.5μg/kg and maintenance dose of 0.2μg/(kg·h);Group C of patients received large dose of dexmedetomidine,loading dose 1.0μg/kg,maintenance dose 0.4μg/(kg·h).The perioperative indexes(recovery time,extubation time,total fentanyl use,total propofol use,total vecuronium usage,intravenous infusion volume,blood loss,operation time,anesthesia time and modified Aldrete score),middle cerebral artery flow velocity(MCAFV),heart rate(HR),mean arterial pressure(MAP),partial pressure of carbon dioxide(PaCO2)were recorded and compared among the three groups 2)Transient hyperemic response ratio(THRR),compression rate(CR),absolute CO2 reactivity,relative CO2 reactivity and pulsatility index were measured recorded and compared among the three groups.Results The total fentanyl usage,total vecuronium usage and blood loss in Group C were lower than those in Group A and Group B(P<0.05).There was no significant difference in THRR,CR,absolute CO2 reactivity,relative CO2 reactivity and pulsatility index among the three groups(P>0.05).There was no significant difference in HR,MAP,PaCO2 and MCAFV between the three groups before and after ventilation(P>0.05).Conclusion The dynamic cerebral regulation and CO2 reactivity of patients with lumbar spine fracture treated with minimally invasive surgery under sevoflurane are not easily affecte

关 键 词：右美托咪定 七氟醚 腰椎骨折 微创 动态脑自动调节 CO2反应性 

分 类 号：R614[医药卫生—麻醉学]