右美托咪啶在三叉神经痛合并高血压微血管减压术麻醉中的应用

目的观察右美托咪啶在微血管减压术治疗三叉神经痛合并高血压患者麻醉中的应用效果。方法 60例合并Ⅰ^Ⅱ级高血压的三叉神经痛患者随机分为观察组和对照组,每组30例,分别于麻醉诱导前静脉输注右美托咪啶1μg·kg-1和等量生理盐水。术中观察组患者给予右美托咪啶0.2Ⅱ级高血压的三叉神经痛患者随机分为观察组和对照组,每组30例,分别于麻醉诱导前静脉输注右美托咪啶1μg·kg-1和等量生理盐水。术中观察组患者给予右美托咪啶0.2⁰.7μg·kg-1·h-1持续泵注,对照组患者给予等量生理盐水持续泵注。术中采用靶控输注丙泊酚和瑞芬太尼进行麻醉维持,肌肉松弛药选用罗库溴铵,采用乌拉地尔辅助控制血压。分别记录输注右美托咪啶或生理盐水前(T0)、麻醉诱导前(T1)、气管插管前(T2)、气管插管后1 min(T3)、手术切皮时(T4)、拔出气管导管前(T5)及拔出气管导管后1 min(T6)患者的心率(HR)和平均动脉压(MAP),记录乌拉地尔、丙泊酚和瑞芬太尼总用量,观察麻醉后恢复情况。结果对照组患者T3时的HR、MAP与T2比较明显升高(P<0.05),T6时的MAP、HR与T5时比较明显升高(P<0.05),T1与T0、T2与T1、T4与T3、T5与T4比较差异无统计学意义(P>0.05)。观察组患者T1时的MAP、HR与T0比较明显降低(P<0.05),T10.7μg·kg-1·h-1持续泵注,对照组患者给予等量生理盐水持续泵注。术中采用靶控输注丙泊酚和瑞芬太尼进行麻醉维持,肌肉松弛药选用罗库溴铵,采用乌拉地尔辅助控制血压。分别记录输注右美托咪啶或生理盐水前(T0)、麻醉诱导前(T1)、气管插管前(T2)、气管插管后1 min(T3)、手术切皮时(T4)、拔出气管导管前(T5)及拔出气管导管后1 min(T6)患者的心率(HR)和平均动脉压(MAP),记录乌拉地尔、丙泊酚和瑞芬太尼总用量,观察麻醉后恢复情况。结果对照组患者T3时的HR、MAP与T2比较明显升高(P<0.05),T6时的MAP、HR与T5时比较明显升高(P<0.05),T1与T0、T2与T1、T4与T3、T5与T4比较差异无统计学意义(P>0.05)。观察组患者T1时的MAP、HR与T0比较明显降低(P<0.05),T1^T6相邻时间点比较差异无统计学意义(P>0.05)。在T1、T2、T3、T4、T5、T6时间点,观察组患者的MAP、HR与对照组比较均显著降低(P<0.05)。观察组丙泊酚、瑞芬太尼及乌拉地尔用量均少于对照组(P<0.05)。停止给药后观察组意识恢复时间、拔出气管导管时间与对照组比较差异无统计学意义(P>0.05),拔出气管导管时呛咳、拔管后躁动及术后寒战发生率均显著低于对照组(P<0.05)。结论右美托咪啶应用于三叉神经痛合并高血压患者行微血管减压术时,围麻醉期可维持更稳定的血流动力学状态,能明显减少麻醉用药量,改善苏醒质量。

Application of dexmedetomidine in patients with trigeminal neuralgia associated with hypertension undergoing microvascular decompression

Objective To detect the application of dexmedetomidine in patients with trigeminal neuralgia associated with hypertension undergoing microvascular decompression （MVD）. Methods A total of 60 patients （ American Society of Anesthesiologists Ⅰ - Ⅱ ）with trigeminal neuralgia associated with hypertension undergoing MVD were randomly divided into observation group and control group, with 30 cases in each group. Dexmedetomidine was injected with the load dosage 1 μg·kg^-1 before anesthesia,followed by the maintaining dosage 0.2 -0.7 μg·kg^-1· h^-1 during anesthesia in the observation group. Sodium chloride injection was pumped in the control group. Anesthesia was maintained by target cotrolled infusion with propofol and remifentanil. Muscle relaxant was maintained with rocuronium. Mean artery pressure （MAP） and heart rate （HR） were monitored and recorded before injecting dexmedetomidine or sodiumchloride （ TO ） , before induction （ T1 ） , before intubation （T2 ）, one min after intubation（ T3 ）, at cutting skin time （T4 ） , before tracheal extubation （T5 ）, and after tracheal extubation（ T6 ）. The mean dosage of propofol and remifentanil were observed. The recovery of patients was observed. Results MAP and HR at T2 were significantly lower than those at T3 in the control group（ P 〈 0.05 ）, MAP and HR at T6 were signifi- cantly lower than those at T5 in the control group （ P 〈 0.05 ）. Compared T1 to T0, T2 to T1, T4 to T3 , T5 to T4, MAP and HR in control group showed no statistical significance（ P 〉 0.05）. MAP and HR at T1 were significantly lower than those at To in the observation group（ P 〈 0. 05 ）, MAP and HR at other two adjacent time points（ T1 -T6 ） in observation group showed no statis- tical significance （ P 〉 0.05 ）. MAP and HR at T1, T2, T3 , T4, T5 and T6 in observation group were significantly lower than those in the control group（ P 〈 0.05 ）. The propofol, remifentanil consumption and ebrantil （urapidil）in the o