摘要
目的比较在颅内动脉瘤夹闭术中右美托咪啶或硝酸甘油控制性降压的效果及对脑氧代谢的影响。方法60例行颅内动脉瘤夹闭术患者，采用随机数字表法分为右美托咪啶组（D组）和硝酸甘油组（N组oD组泵注右美托咪啶，首剂量1．0μg／l（g（泵注10min），0．4μg·kg-1.h-1～0．8μg·k-1·h-1维持；N组泵注硝酸甘油，首剂量3μg·kg·min，10min后3μg·kg-1 h-1-9μg·kg-1．min。维持。记录麻醉诱导前（T），控制性降压开始后0（To）、10（T1）、20（T2）、30rain（T3）和停止降压后30min（T4）的平均动脉压（MAP）、心率（HR），同时采集桡动脉血和颈内静脉球部血行血气分析，计算脑氧摄取率（cerebraloxygenextractionrate，CERO：）。结果实施控制性降压后，两组MAP均在30min内达到目标血压。降压期间，HR：D组L时（66±0）,Jmin低于R时（76±9）7,min（P〈0．05），N组T3时（86±8）次／min高于Tn时（77±8）次，min（P〈0．05）；CER02：D组T3时（27±6）％低于Tn时（35±6）％（P〈0．05）；N组rr3时（32±6）％与T0时（34±5）％差异无统计学意义（P〉0．05）。D组CERO与MAP呈正相关（r=0．83）。结论右美托咪啶用于颅内动脉瘤术中控制性降压安全、可靠。与硝酸甘油比较，有减慢HR，降低术中脑氧代谢率的优点。
Objective To compare the effect of dexmedetomidine and nitroglycerin for controlled hypotension and the changes in cerebral oxygen metabolism during intracranial aneurysm surgery. Methods 60 patients with intracranial aneurysm surgery were randomly divided into 2 groups（n=30 each group）： dexmedetomidine group （group D） and nitroglycerin group （group N）. Group D： Continuous infusion of dexmedetomidine was start at 1 μg/kg 10 min later, adjust infusion rate to 0.4 μg-1 h-l-0.8 μg .kg-l .h-1 according the changes of mean arterial pressure （MAP）. Group N： continuous infusion of nitroglycerin was start at 3 μg.kg-1 .min-1. 10 min later, adjust infusion rate to 3 μg.kg-1 h-1-9 μg.kg.1 .min-1according the changes of MAP. MAP and heart rate （HR） were recorded at before induction,at controlled hypotension,10, 20 min and 30 min after controlled hypotension and 30 min end of controlled hypotension （T,T0,T1,T2,T3,T4）. Simultaneous acquisition radial artery and jugular venous bulb blood line blood gas analysis, calculation of cerebral oxygen uptake rate （CERO2）. Results MAP in the two groups reached the target blood pressure within 30 min of controlled hypotension started. During controlled hypotension, HR and CERO2 in group D：T3 [（66±10） bpm, （27±6） %） was lower than To （76±9） bpm, （35±6）%] （P〈0.05）. HR in group N：T3 （86±8） bpm was higher than To （778） bpm（P〈0.05）. There were no significant of CERO2 between T3 （32±6）% and To （34±5）% in group N （P〉0.05）. CERO2 and MAP was positively correlated in group D （r=0.83）. Conclusions Dexmedetomidine for controlled hypotension in intracranial aneurysm surgery is safe and reliable. Compared with nitroglycerin, dexmedetomidine can reduce HR and cerebral oxygen metabolism.
出处
《国际麻醉学与复苏杂志》
CAS
2013年第3期206-209,共4页
International Journal of Anesthesiology and Resuscitation
关键词
右美托咪啶
控制性降压
硝酸甘油
颅内动脉瘤
脑氧代谢率
Dexmedetomidine
Hypotension controlled
Nitroglycerin
Cerebral oxygen metabolism
Intracranialaneurysm
