三叉神经痛微血管减压术中右美托咪啶应用观察

目的研究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。方法本研究对象为合并Ⅰ~Ⅱ级高血压的三叉神经痛患者100例,随机分成研究组(50例)与对照组(50例),分别在麻醉诱导前静脉输注右美托咪啶以及等量生理盐水。手术期间,研究组持续泵注右美托咪啶,对照组实施等量生理盐水持续泵注,采取靶控输注丙泊酚以及瑞芬太尼麻醉维持,并以罗库溴铵作为肌肉松弛药,采用乌拉地尔辅助控制血压。于输注右美托咪啶或生理盐水前、麻醉诱导前、气管插管前、气管插管后1min、手术切皮时以及拔出气管导管前和拔出气管导管后1min,对患者的心率及平均动脉压进行统计,并记录乌拉地尔以及瑞芬太尼、丙泊酚的总用量,观察患者麻醉后的恢复情况。结果气管插管后1min时,对照组心率、平均动脉压与气管插管前对比显著提升(P0.05);拔出气管导管后,两项指标与拔出气管导管前相比显著提升(P0.05)。研究组麻醉诱导前患者的心率以及平均动脉压明显低于输注右美托咪啶或生理盐水前(P0.05),丙泊酚及瑞芬太尼、乌拉地尔用量与对照组相比明显较少(P0.05)。与对照组相比,研究组拔出气管导管时呛咳及拔管后躁动、术后寒战的发生情况明显较低(P0.05)。结论三叉神经痛合并高血压患者微血管减压术期间应用右美托咪啶,围麻醉期能够对血流动力学状态进行良好的维持,显著减少麻醉用药量。

Effect of dexmedetomidine in anesthesia of patients with prosopalgia and hypertension during microvacular decompression

Objective To study the effect of demedetomidine in anesthesia of patients with prosopalgia combined with hypertension during microvacular decompression.Methods A total of 100 patients with prosopalgia combined with hypertension of level Ⅰ-Ⅱ were selected as research objects.They were randomly divided into research group (50 patients) and control group (50 patients),and given with intravenous infusion of dexmedetomidine and identical volume of normal saline (NS) before anesthesia induction.During operation period,the research group applied continuous pump infusion of dexmedetomidine,while control group applied continuous pump infusion of identical volume of NS.Moreover,during operation,target controlled infusion of disoprofol was performed,anesthesia maintenance with remifentanil was conducted,and rocuronium bromide was used as muscle relaxant,and auxiliary control of blood pressure was conducted using urapidil.In addition,we recorded patients' heart rate (HR) and mean arterial pressure (MAP) at various time points including before infusion of dexmedetomidine or NS,before anesthesia induction,before trachea cannula,within 1 minute after trachea cannula,when conducting skin incision,before pulling out endotracheal tube,and within 1 minute after pulling out endotracheal tube,recorded the real-time total dosage of urapidil,remifentanil,and disoprofol,and observed the recovery condition of patients after anesthesia.Results The statistical results showed that the HR and MAP of control group within 1 minute after pulling out endotracheal tube was significantly increased compared with that before pulling out endotracheal tube (P＜0.05);the levels of two indexes after pulling out endotracheal tube were significantly higher than those before pulling out endotracheal tube(P＜0.05);the HR and MAP of research group before anesthesia induction were significantly lower than that before infusion of dexmedetomidine or NS (P＜0.05);the dosage of urapidil,remifentanil,and disoprofol of research group was significantly lower than that of control group (P＜0.05).Compared with control group,the rate of Cough when pulling out endotracheal tube,rate of dysphoria after pulling out endotracheal tube,and rate of postoperative shivering of research group were significantly lower (P ＜ 0.05).Conclusion During conducting microvacular decompression for patients with prosopalgia combined with hypertension,the application of dexmedetomidine can well maintain the hemodynamic status during perianesthesia care,and allow a significantly reduced dosage of anaesthetic.