右美托咪啶在颅内动脉瘤血管内栓塞术中的应用价值

目的 研究颅内动脉瘤血管内栓塞术中应用右美托眯啶对丙泊酚靶控输注效应的影响.方法 选择神经介入行颅内动脉瘤血管内栓塞术的患者60例（ASA Ⅰ～Ⅱ级）,随机分为右美托咪啶组（Dex组）和对照组（C组）.Dex组首先给予0.5μg/kg右美托咪啶静注（10 min注射完毕）,C组给予相同方法静注等容量生理盐水;观察10 min之后开始诱导麻醉.记录给药前（T0）、给药后1 min（T1）、5 min （T2）、10 min（T3）、插喉罩前（T4）、插喉罩成功后即刻（T5）、插喉罩后1 min（T6）、3 min （T7）的心率（HR）、有创动脉血压收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）]、脑电双频指数（BIS）、警觉与镇静评分（OAA/S评分）、Ramesay镇静评分及丙泊酚血浆靶浓度.观察停止麻醉后自主呼吸恢复、初醒（呼之睁眼）、清醒拔除喉罩及定向力恢复时间;随访术中知晓情况.结果 Dex组在给予右美托咪啶后BIS值比基础值降低（15.9±5.8）％（P＜0.05）,OAA/S评分比基础值降低（1.4±0.5）分（P＜0.05）,Ramesay评分比基础值升高（1.4±0.6）分（P＜0.05）,而C组无明显变化.与T0相比,两组MAP和HR在T4-7时刻均明显降低,而Dex组降低幅度小于C组（P＜0.05）.诱导所需丙泊酚血浆靶浓度Dex组为（2.5±0.4）μg/mL,C组为（3.7±0.6）μg/mL,差异有统计学意义（P＜0.05）.术中丙泊酚用量Dex组为（601±253）mg,明显小于C组丙泊酚用量（795±219）mg]（P＜ 0.05）.Dex组患者呼之睁眼时间（5.2±3.7）min]、清醒拔除喉罩时间（8.3±4.2）min]及定向力恢复时间（9.8±4.4）min]明显快于C组患者（7.1±3.5）、（10.2±3.9）、（12.1±4.1）min]（P＜ 0.05）.结论 颅内动脉瘤栓塞术术前应用右美托咪啶可以有效抑制麻醉诱导及术中心血管反应,降低丙泊酚用量,缩短麻醉恢复时间.

The application value of Dexmedetomidine in the operation of endovascular embolization for intracranial aneurysms

Objective To research the effect of Dexmedetomidine to propofol target-controlled infusion during the operation of endovascular embolization for intracranial aneurysms.Methods 60 cases of intracranial aneurysms （degree Ⅰ-Ⅱ of ASA） who needed the operation of endovascular embolization were divided randomly into the Dexmedetomidine group （Dex group） and control group （group C）.Dex group was given the intravenous injection of Dexmedetomidine （0.5 μg/kg,finished in 10 min） at first,group C was given the intravenous injection of the same volume of physiological saline; induced anesthesia was began after observation for ten minutes.The heart rate （HR）,invasive arterial blood pressure （SBP,DBP,MAP）,bispectral index （BIS）,the observer＇s assessment of alert-ness/sedation （OAA/S） scale,Ramesay sedation score and plasm concentration of Propofol were recorded at the time of pre-administration （T0）,1 min after administration （T1）,5 min after administration （T2）,10 min after administration （T3）,the time before laryngeal mask （T4）,the time after successful laryngeal mask immediately （T5）,1 min after laryngeal mask （T6）,3 min after laryngeal mask （T7） respectively.The situations of the recovery of spontaneous breathing,waking up early （opening eye by calling）,extraction of laryngeal mask under awake and time of orientation recovery were observed.The awareness status during operation was also followed up.Results For Dex group,the value of BIS decreased by （15.9±5.8）％ from basement （P ＜ 0.05）,the score of OAA/S decreased by （1.4±0.5） points from basement （P ＜0.05）,the Ramesay score increased by （1.4±0.6） points from basement （P ＜ 0.05）; while these values in the group C had no significant difference.The values of MAP and HR at the time of T4-7 in the two groups were both significantly reduced compared to these values at the time of T0,and the extent of reduction in Dex group was lower than it in group C （P ＜ 0.05）.The plasm concentration of Propofol for induction of anesthesia （2.5±0.4） μg/mL] in the Dex group was significantly different from it in the group C （3.7±0.6） μg/mL] （P ＜ 0.05）; the dose of propofol （601±253） mg] in Dex group during operation was significantly lower than that in group C （795±219） mg] （P ＜0.05）.The time of opening eye by calling （5.2±3.7） min],extraction of laryngeal mask under awake （8.3±4.2） min] and orientation recovery （9.8±4.4） min] in Dex group were all shorten than the time in group C （7.1±3.5）,（10.2±3.9）,（12.1±4.1） min] （P ＜0.05）.Conclusion The application of Dexmedetomidine for the operation of endovascular embolization for intracranial aneurysms can effectively inhibit the reaction of induction of anesthesia and cardiovascular response,reduce the dose of Propofol,and shorten the recovery time of anesthesia.