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右美托咪定对颅内动脉瘤栓塞术患者局部脑氧饱和度和脑功能的影响
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篇名: 右美托咪定对颅内动脉瘤栓塞术患者局部脑氧饱和度和脑功能的影响
TITLE: Effects of Dexmedetomidine on Regional Cerebral Oxygen Saturation and Cerebral Function in Patients underwent Intracranial Aneurysm Embolization
摘要: 目的:探讨右美托咪定对颅内动脉瘤栓塞术患者局部脑氧饱和度、脑功能的影响。方法:选择2017年6月-2019年8月湖南中医药大学第一附属医院收治的行颅内动脉瘤栓塞术患者44例,按随机数字表法分为D组(22例)和C组(22例)。麻醉诱导前10min,D组患者静脉滴注盐酸右美托咪定注射液1μg/kg,C组患者静脉滴注缓冲生理盐水20μL;两组患者均以丙泊酚乳状注射液+咪达唑仑注射液+枸橼酸芬太尼注射液+注射用苯磺顺阿曲库铵进行麻醉诱导。术中,D组患者静脉滴注盐酸右美托咪定注射液0.5μg(/kg·h)+枸橼酸芬太尼注射液+注射用苯磺顺阿曲库铵+丙泊酚乳状注射液进行麻醉维持,C组患者静脉滴注缓冲生理盐水0.5μg(/kg·h)+枸橼酸芬太尼注射液+注射用苯磺顺阿曲库铵+丙泊酚乳状注射液进行麻醉维持。观察两组患者麻醉诱导前(T0)、麻醉诱导即刻(T1)、气管插管后1min(T2)、术毕即刻(T3)、拔管即刻(T4)时的平均动脉压(MAP)、心率(HR)、局部脑氧饱和度(rSO2),检测其T1、T3、术毕6h(T6)时的血清神经元特异性烯醇化酶(NSE)、S100β蛋白水平,记录其麻醉苏醒时间、术中出血量、硝酸甘油使用量及不良反应发生情况。结果:D组患者T2~T4时的MAP、HR显著低于同组T0时,C组患者T2~T4时的MAP、HR显著高于同组T0时,且D组显著低于C组同期(P<0.05);两组患者T0~T4时的rSO2比较,差异均无统计学意义(P>0.05)。两组患者T3时的血清NSE、S100β蛋白水平均显著高于同组T1时,T6时的血清NSE、S100β蛋白水平均显著低于同组T3时,但T3时D组显著低于C组同期(P<0.05);两组患者T6时的血清NSE、S100β蛋白水平与T1时比较,差异均无统计学意义(P>0.05)。D组患者麻醉苏醒时间、硝酸甘油使用量、心动过速、恶心呕吐、躁动、寒战、呛咳发生率均显著短于或低于C组(P<0.05);而两组患者术中出血量比较,差异无统计学意义(P>0.05)。结论:右美托咪定可维持颅内动脉瘤栓塞术患者围术期血流动力学稳定,对rSO2、脑功能影响小,且安全性较好。
ABSTRACT: OBJECTIVE:To investigate the effects of dexmedetomidine on regional cerebral oxygen saturation and cerebral function in patients undergoing intracranial aneurysm embolization. METHODS :Totally 44 patients undergoing intracranial aneurysm embolization in the First Affiliated Hospital of Hunan University of TCM during Jun. 2017-Aug. 2019 were collected and randomly divided into group D (22 cases)and group C (22 cases). Ten minutes before anesthesia induction ,group D was given intravenous injection of Dexmedetomidine hydrochloride injection 1 μg/kg;group C was given buffered normal saline 20 μL. Both groups were induced with Propofol emulsion injection+Midazolam injection+Fentanyl citrate injection+Cisatracurium besylate for injection. During the operation ,group D was given Dexmedetomidine hydrochloride injection 0.5 μg(/ kg·h)+Fentanyl citrate injection+Benzsulfosum atracurium for injection+Propofol emulsion injection to maintain anesthesia ;group C was continuously pumped with buffered normal saline 0.5 μg(/ kg·h)+Fentanyl citrate injection + Benzsulfosum aratracurium for injection Propofol emulsion injection to maintain anesthesia. Before anesthesia induction (T0), immediately after anesthesia。induction (T1), 1 min after tracheal intubation (T2), immediately after operation finished (T3),immediately afte extubation(T4),the mean arterial pressure(MAP),heart rate 澳门游戏网投排行平台 2021年第32卷第7期 China Pharmacy 2021Vol. 32 No. 7 ·865· (HR),regional cerebral oxygen satur ation(rSO2)were observed in 2 groups. The levels of neuron specific enolase (NSE)and S100 β protein in serum were measured at T1,T3,6 h after operation (T6). The recovery time ,intraoperative blood loss , nitroglycerin amount and the occurrence of ADR were recorded. RESULTS :MAP and HR of group D at T 2-T4 were significantly lower than those at T 0;MAP and HR of group C at T 2-T4 were significantly higher than those at T 0;the group D were significantly lower than the group C at the same period (P<0.05);there was no statistical significance in rSO 2 between 2 groups at T 0-T4(P> 0.05). The levels of serum NSE and S 100β protein in 2 groups at T 3 were significantly higher than at T 1;those in 2 groups at T 6 were significantly lower than at T 3,but those of group D were significantly lower than the group C at T 3(P<0.05);there was no statistical significance in the levels of serum NSE or S 100β protein between 2 groups at T 1(P>0.05). The recovery time of anesthesia,the amount of nitroglycerin ,the incidence of tachycardia ,nausea and vomiting ,restlessness,shivering and cough in group D were significantly shorter or lower than group C (P<0.05);there was no statistical significance in the intraoperative blood loss between 2 groups(P>0.05). CONCLUSIONS :Dexmedetomidine can maintain the hemodynamic stability of patients with intracranial aneurysm embolization during the perioperative period ,has little effect on rSO 2 and brain function ,and has good safety.
期刊: 2021年第32卷第07期
编辑: 雷华娟,滕永杰,周启,陈梦,李春辉,何金晶,肖薪雨,马存,刘柏炎
AUTHORS: LEI Huajuan,TENG Yongjie,ZHOU Qi,CHEN Meng,LI Chunhui,HE Jinjing,XIAO Xinyu,MA Cun,LIU Boyan
关键字: 颅内动脉瘤;栓塞术;右美托咪定;局部脑氧饱和度;血流动力学;脑功能;安全性
KEYWORDS: Intracranial aneurysm ;Embolization;Dexmedetomidine;Regional cerebral oxygen saturation ;Hemodynamics;
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