颅内动脉瘤介入患者术中及苏醒期血流动力学变化趋势及临床药物干预效果

目的 探讨颅内动脉瘤介入患者术中及苏醒期血流动力学变化趋势及临床药物干预效果。方法 选取该院颅内动脉瘤介入手术患者86例（2017年11月—2019年6月），随机数字表法分为研究组（n=43）与对照组（n=43）。对照组采取瑞芬太尼+七氟醚，研究组在对照组基础上加用右美托咪定。统计两组围术期[麻醉诱导前（T0）、气管插管后（T1）、麻醉后15 min （T2）、术毕（T3）]血流动力学指水平、脑氧代谢情况、拔管、睁眼及恢复自主呼吸用时、不良反应。结果 （1）血流动力学：①不同时间点的HR、MAP、SBP、SPO₂有差别（P<0.05），②组间HR、MAP、SBP、SPO₂有差别（P<0.05），③研究组与对照组的HR、MAP、SBP、SPO₂变化趋势有差别（P<0.05）；（2）脑氧代谢：①不同时间点的CERO₂、Da-jvO₂有差别（P<0.05），②组间CERO₂、Da-jvO₂有差别（P<0.05），③研究组与对照组的CERO₂、Da-jvO₂变化趋势有差别（P<0.05）；（3）拔管、睁眼及恢复自主呼吸用时：研究组拔管时间短于对照组（P<0.05），睁眼时间、恢复自主呼吸时间与对照组比较，差异无统计学意义（P>0.05）；（4）不良反应：研究组不良反应发生率（13.95%）低于对照组（32.56%）（P<0.05）。结论 颅内动脉瘤介入手术患者术中及苏醒期血流动力学异常波动，通过右美托咪定复合七氟醚可抑制其波动程度，并能改善脑氧代谢状态，缩短术后拔管时间，且不良反应发生率较低，此方法安全可靠。

Changes of hemodynamics during operation and recovery period in patients with intracranial aneurysms undergoing interventional surgery and the effect of clinical drug intervention

Objective To investigate the trend of hemodynamic changes in patients with intracranial aneurysms undergoing interventional surgery during operation and recovery period and the effect of clinical drug intervention.Methods 86 patients with intracranial aneurysms undergoing interventional surgery in our hospital (November 2017-June 2019) were randomly divided into study group (n=43) and control group (n=43).The control group was treated with remifentanil and sevoflurane, while the study group was treated with dexmedetomidine on the basis of the control group.The perioperative hemodynamic indexes, cerebral oxygen metabolism, extubation, eye opening and recovery of spontaneous breathing, and adverse reactions of the two groups were counted before anesthesia induction (T0), after tracheal intubation (T1), 15 minutes after anesthesia (T2), and after operation (T3).Results (1) Hemodynamics: (i) Differences in HR, MAP, SBP and SPO₂ at different time points (P<0.05), (ii) differences in HR, MAP, SBP and SPO₂ between groups (P<0.05) and (iii) differences in trends in HR, MAP, SBP and SPO₂ between study and control groups (P<0.05). (2) Cerebral oxygen metabolism: (i) Differences in CERO₂ and Da-jvO₂ at different time points (P<0.05), (ii) differences in CERO₂ and Da-jvO₂ between groups (P<0.05) and (iii) differences in trends in CERO₂ and Da-jvO₂ between study and control groups (P<0.05). (3) Extubation, eye opening and recovery of spontaneous breathing time: the extubation time of the study group was shorter than that of the control group (P<0.05), and there was no significant difference in the opening time and recovery of spontaneous breathing time between the study group and the control group (P>0.05).(4) Adverse reactions: The incidence of adverse reactions in the study group (13.95%) was lower than that in the control group (32.56%) (P<0.05).Conclusions Abnormal hemodynamic fluctuations in intracranial aneurysm patients during operation and recovery period can be inhibited by dexmedetomidine combined with sevoflurane, which can improve cerebral oxygen metabolism, shorten the extubation time after operation, and the incidence of adverse reactions is low, so it is safe.