右美托咪定或瑞芬太尼复合七氟烷对颅内动脉瘤介入手术患者血流动力学、神经功能和苏醒质量的影响

目的 探讨右美托咪定或瑞芬太尼复合七氟烷对颅内动脉瘤介入手术患者血流动力学、神经功能及苏醒质量的影响。方法 选取2019年1月—2020年3月在南阳南石医院行颅内动脉瘤介入术80例患者作为研究对象，以随机数字表法简单随机分组为对照组与观察组各40例。对照组给予瑞芬太尼复合七氟烷，观察组给予盐酸右美托咪定复合七氟烷。比较两组麻醉诱导前（T0）、气管插管后1 min（T1）、手术开始（T2）、拔管前（T3）、拔管后10 min（T4）血流动力学指标变化，评价术前、术后1周、术后2周美国国立卫生研究院卒中量表（NIHSS）评分、Barthel指数，以及苏醒质量。结果 观察组心率（HR）、平均动脉压（MAP）、颅内压（ICP）在T1、T2、T3、T4时明显低于对照组（P<0.05）。观察组NIHSS评分在术后1周、2周明显低于对照组，Barthel指数明显高于对照组（P<0.05）。观察组苏醒时间、拔管时间明显长于对照组（P<0.05），拔管后躁动发生率观察组（5.00%）明显低于对照组（20.00%）（P<0.05）。结论 相对于瑞芬太尼复合七氟烷，盐酸右美托咪定复合七氟烷应用于颅内动脉瘤介入手术，可更有效稳定血流动力学，改善神经功能，提高麻醉苏醒质量。

Effects of dexmedetomidine or remifentanil combined with sevoflurane on hemodynamics, neurological function and recovery quality of patients undergoing intracranial aneurysm interventional surgery

Objective To explore the effect of dexmedetomidine or remifentanil combined with sevoflurane on hemodynamics, nerve function, and recovery quality of patients undergoing intracranial aneurysm intervention. Methods A total of 80 patients undergoing intracranial aneurysm interventional surgery in Nanshi Hospital of Nanyang from January 2019 to March 2020 were selected as the research subjects, and were randomly divided into control group and observation group with 40 patients in each group by random number table method. Patients in the control group were given remifentanil combined with sevoflurane, and the observation group were given dexmedetomidine combined with sevoflurane. Hemodynamic changes before anesthesia induction (T0), 1 min after endotracheal intubation (T1), the beginning of surgery (T2), before extubation (T3), and 10 min after extubation (T4) were compared between two groups. National Institutes of Health Stroke Scale (NIHSS) score and Barthel index were compared before, 1 week and 2 weeks after surgery. And the quality of awakening were observed. Results Heart rate (HR), mean arterial pressure (MAP), and intracranial pressure (ICP) in observation group were significantly lower than those in control group at T1, T2, T3 and T4 (P < 0.05). NIHSS score of the observation group was significantly lower than that of the control group 1 and 2 weeks after surgery, and Barthel index was significantly higher than those of the control group (P < 0.05). The recovery time and extubation time in the observation group were significantly longer than those in the control group (P < 0.05). The incidence of post-extubation agitation in the observation group (5.00%) was significantly lower than that in the control group (20.00%) (P < 0.05). Conclusion Compared with remifentanil and sevoflurane, the application of dexmedetomidine hydrochloride and sevoflurane in interventional surgery for intracranial aneurysm can more effectively stabilize hemodynamics, improve neurological function and improve the quality of anesthesia recovery.