右美托咪定对脑功能区肿瘤切除术术中唤醒效果及应激反应的影响

目的：：评价右美托咪定对脑功能区肿瘤切除术术中唤醒质量和应激反应的影响,为临床麻醉用药提供参考依据。方法：拟行术中唤醒试验的脑功能区肿瘤切除术患者50例,随机均分为观察组和对照组各25例,观察组在诱导前10min 静脉输注负荷剂量的右美托咪定1.0μg / kg,然后以0.2μg?kg－1?h－1的速率维持,对照组给予同量的0.9％氯化钠注射液,观察唤醒前情况,唤醒时间、唤醒质量及唤醒期间不良事件,检测入室时、唤醒后5min 和手术结束时血浆中去甲肾上腺素(NE)和肾上腺素(E)水平。结果：①观察组患者唤醒前麻醉时间、失血量及尿量,与对照组相似,差异无统计学意义( P >0.05)；但观察组唤醒前丙泊酚及瑞芬太尼用量明显少于对照组,差异有统计学意义(P<0.05)。②观察组患者唤醒时间短于对照组,唤醒质量优于对照组,差异有统计学意义(P<0.05)；对照组唤醒期间不良事件发生率44.00％,明显高于观察组的12.00％,差异有统计学意义( P <0.05)。③两组患者入室时血浆NE 和 E 水平相似,差异无统计学意义(P>0.05)；唤醒后5min 和手术结束时血浆 NE 和 E 水平较本组入室时均升高,但对照组升高幅度更大,差异有统计学意义(P<0.05)。结论：脑功能区肿瘤行切除术患者应用右美托咪定能减少麻醉药物用量,降低血浆 NE 和 E 浓度,较好的抑制麻醉唤醒时的应激反应,提高唤醒质量,减少不良反应发生率。

Dexmedetomidine on Intraoperative Stress Reaction and Analepsia in the Resection of Tumors of Cerebral Functional Area

Objective: To evaluate the effects of dexmedetomidine on the intraoperative stress reaction and analepsia in the resection of tumors of cerebral functional area, to provide reference foundations for clini-cal medication for anesthesia. Methods: A total of 50 patients scheduled for intraoperative wake-up test in the resection of tumors of cerebral functional area were randomly divided into observation group and control group, with 25 cases in each group. The observation group was intravenously dripped with a loading dose (1.0μg / kg) of dexmedetomidine at 10min before induction, and then was maintained at 0.2μg?kg-1?h-1; while the con-trol group was given the same dose of 0.9% sodium chloride injection, and the pre-analepsia conditions, times to analepsia, qualities of analepsia, and adverse events in wake-up period were observed, and the plasma lev-els of norepinephrine (NE) and epinephrine (E) on room-entering, at 5min after analepsia, and at the end of the surgery were determined. Results:The patients of the two groups had insignificantly different pre-an-alepsia anesthesia times, blood losses, and urinary volumes (P>0.05); but the observation group had signifi-cantly lower doses of propofol and remifentanil used before analepsia than the control group (P <0.05). The patients of the observation group had significantly shorter time to analepsia and significantly better quality of analepsia than the control group (P <0.05); The incidence of adverse events of the patients of the control group was 44.00%, and was significantly higher than that of the observation group (12.00%) (P<0.05). The patients of the two groups had insignificantly different plasma levels of NE and E on room-entering (P >0. 05); Both groups had significantly increased plasma levels of NE and E at 5min after analepsia and at the end of the surgery compared with those on room-entering, but the control group had significantly greater increasing extents (P<0.05). Conclusion: Use of dexmedetomidine in patients undergoing resection of tumors of cerebral functional area can reduce the dose of narcotics, decrease the plasma concentrations of NE and E, elevate the quality of analepsia, and reduce the incidence of adverse reactions.