右美托咪啶对神经外科患者术中血流动力学的影响

目的探讨右美托咪啶对神经外科手术患者术中血流动力学的影响。方法择期行后颅窝手术、全凭静脉插管全麻的患者40例,随机分成生理盐水组(C组)和右美托咪啶组(D组),每组20例。麻醉诱导气管插管后,D组静脉泵注右美托咪啶0.8μg·kg-1·h-1,C组泵注等量生理盐水。术中持续泵注丙泊酚、瑞芬太尼,按需追加维库溴铵维持麻醉,BIS值维持在40～55。分别于麻醉诱导前(T0)、麻醉诱导后即刻(T1)和诱导后15min在(T2)、切皮时(T3)、切皮后10min(T4)、颅骨钻孔时(T5)和术毕(T6)记录HR、SBP、DBP、BIS值,统计麻醉维持中丙泊酚和瑞芬太尼的用量。结果 T1、T2时两组SBP均较T0时下降,T2时两组HR也下降(P均<0.05);T3时,C组HR明显高于D组(P<0.05),两组SBP均明显上升,组间差异无统计学意义(P>0.05);T5时,C组HR、SBP明显高于D组(右美托咪啶;神经外科;丙泊酚;瑞芬太尼;血流动力学(P<0.05);T6时,两组HR均升高,且C组较D组升高明显(P<0.05),C组SBP较T0时明显增高(P<0.05),D组SBP较T0时略降低,两组间差异有统计学意义(P<0.05)。麻醉维持中丙泊酚和瑞芬太尼用量,D组较C组分别降低30.93%(P<0.01)和7.69%(P<0.05)。结论麻醉维持中辅助用右美托咪啶0.8μg·kg-·1h-1,可使神经外科手术患者术中血流动力学更平稳,并降低丙泊酚和瑞芬太尼用量。

Effect of dexmedetomidine on hemodynamics in patients undergoing neurosurgery

Objective To investigate the effects of dexmedetomidine on hemodynamics in patients undergoing neurosurgery.Methods Forty patients undergoing selective posterior fossa surgery were randomly divided into two groups (twenty patients in each group):the control group (group C) and the dexmedetomidine group (group D).After induction and tracheal intubation,group D was administrated with dexmedetomidine 0.8 μg·kg-1·h-1 during the anesthesia,group C was administrated with saline.Anesthesia was maintained with propofol,remifentanil and vecuronium.BIS value was controlled at 40~55 during the whole operation.Heart rate (HR),systolic blood pressure (SBP),diastolic blood pressure (DBP) and bispectral (BIS) were recorded at the moment of before induction (T0),induction (T1),15 minutes after induction (T2),skin incision (T3),10 minutes after skin incision (T4),drilling skull (T5) and at end of operation (T6).The dosage of propofol and remifentanil was recorded.Results SBP in the two groups was significantly decreased at T1 and T2 compared with T0,and HR was significantly decreased at T2 compared with T0 (P<0.05).At T3,HR of group C was significantly higher than that of group D (P <0.05),and SBP in both groups were increased,with no statistically significant difference between the two groups (P>0.05).At T5,HR and SBP of group C were significantly higher than those of group D (P <0.05).At T6,HR of both groups was increased,and the increase in group C was more profound than that in group D (P <0.05).SBP of group C was increased and SBP of group D was decreased at T6 compared with T0,with statistically significant difference between the two groups (P<0.05).The dosage of propofol and remifentnil in group D was decreased 30.93% (P <0.01) and 7.69% (P <0.05) respectively compared with group C.Conclusion Administration with demedetomidinecan 0.8 μg·kg-1·h-1 during maintenance of anesthesia decrease the hemodynamical fluctuations in patients undergoing neurosurgery and reduce the dosage of propofol and remifentanil.