右美托咪定辅助全身麻醉对开颅手术小儿围手术期血流动力学影响的初步研究

目的 观察右美托咪定(dexmedetomidine,Dex)用于开颅手术小儿全身麻醉辅助用药对围手术期血流动力学的影响.方法 本研究为前瞻性、随机、双盲、安慰剂对照的初步研究.选择因颅内肿瘤择期全身麻醉下行开颅手术的患儿52例,年龄4~12岁,采用随机数字表法分为两组(每组26例):Dex组麻醉诱导后予Dex 0.5μg/kg持续静脉输注15 min,之后以0.5μg·kg-1·h-1维持至硬脑膜关闭;对照组予等量生理盐水持续静脉输注.主要观察指标是患儿入室、给药前、给药后15 min、给药后30 min、切皮前、切皮后5 min、上显微镜、撤显微镜、术毕、拔管时、拔管后5 min、拔管后10 min时的SBP、DBP、HR的波动情况.结果 给药后15 min Dex组SBP、DBP与入室值比较,差异无统计学意义(P>0.05),但显著高于对照组分别为(109±12)mmHg(1 mmHg=0.133 kPa)比(101±13)mmHg,(68±13)mmHg比(61±12)mmHg](P<0.05);拔管时,拔管后5、10 min Dex组HR与入室值比较,差异无统计学意义(P>0.05),但显著低于对照组(94±18)次/min比(113±21)次/min、(95±19)次/min比(111±18)次/min、(94±17)次/min比(110±18)次/min](P<0.05);其余各时点SBP、DBP、HR组间比较,差异无统计学意义(P>0.05).丙泊酚用量Dex组显著低于对照组(852±346)mg比(1176±434)mg](P<0.01),苏醒时间及副作用发生率两组间差异无统计学意义(P>0.05).结论 开颅手术小儿全身麻醉期间辅助使用Dex可使围手术期血流动力学更平稳,且不影响苏醒时间、不增加不良事件发生.

Effects of dexmedetomidine as an adjuvant to general anesthesia on perioperative hemodynamic reaction in pediatric patients undergoing craniotomy:a pilot study

Objective To evaluate the effect of dexmedetomidine(Dex) as an adjuvant to general anesthesia on perioperative hemodynamic fluctuation in pediatric patients undergoing craniotomy. Methods This was a prospective, randomized, double-blind and placebo-controlled pilot study. Fifty-two pediatric patients(aged 4-12 years) with intracranial tumor scheduled for craniotomy were randomly assigned into two groups(n=26). After anesthesia induction, one group of patients (Dex group) received a loading dose of Dex (0.5 μg/kg iv infusion for 15 min), followed by a continuous infusion at a rate of 0.5 μg·kg-1·h-1 till the end of the operation, another group of patients (control group) received the same volume of normal saline with the same procedure. Hemodynamic parameters, including SBP, DBP and HR, were monitored throughout the operation. Results Although 15 min Dex infusion did not cause siginificant changes in SBP and DBP (P>0.05), it maintained SBP and DBP at higher levels than control group SBP: Dex group, (109±12) mmHg(1 mmHg=0.133 kPa), control group, (101±13) mmHg. DBP:Dex group, (68±13) mmHg, control group, (61±12) mmHg] (P<0.05). At 5 min and 10 min after extubation, HR in the Dex group were significantly lower than those in the control group After extubation:0 min, (94±18) bpm vs (113±21) bpm. 5 min, (95±19) bpm vs (111±18) bpm. 10 min, (94±17) bpm vs (110±18) bpm](P<0.05). The dose of propofol used for general anesthesia was significantly lower in the Dex group than that in the control group (852±346) mg vs (1176±434) mg](P<0.01). SBP, DBP and HR at other timepoints, recovery time, and incidence of adverse effectswere not significantly different between the two groups (P>0.05). Conclusions Dex attenuated the intraoperative hemodynamic responses and dose of drugs for general anesthesia in pediatric patients undergoing craniotomy, without prolonging recovery time or increasing the incidence of adverse events.