摘要
目的观察右美托咪定对动脉瘤性蛛网膜下腔出血围介入栓塞手术期血流动力学以及继发脑血管痉挛发生的影响。方法选择2012年10月-2015年2月行介入栓塞手术治疗的动脉瘤性蛛网膜下腔出血患者90例,随机分为右美托咪定组与对照组,每组45例。2组患者均给予相同的麻醉诱导,给予芬太尼2~4μg/kg静脉泵入镇痛。对照组患者间断给予丙泊酚0.4~0.6mg/kg进行麻醉维持。右美托咪定组在麻醉诱导期15min内给予右美托咪定0.5~0.8μg/kg,麻醉维持期给予右美托咪定0.2~0.5μg/kg·h-1,拔管前10min调整右美托咪定剂量为0.1~0.2μg/kg。观察2组患者术前（T0）、气管插管后（T1）、脑动脉造影前（T2）、脑动脉造影后10min（T3）、拔管前5min（T4）,拔管后15min（T5）各时间点平均动脉压（MAP）、心率（HR）变化情况。比较2组患者术中脑血管造影显示的血管痉挛发生情况,手术前后大脑中动脉血流速度,术后发生症状性脑血管痉挛情况。结果围手术期,右美托咪定组患者MAP和HR平稳,无大幅升降变化;对照组患者MAP和HR波动幅度较大。2组患者在T0时间点MAP和HR比较,差异无统计学意义;但2组患者在T1,T2,T3,T4时间点的MAP和HR比较,差异均有统计学意义（P〈0.05）。右美托咪定组患者术中脑血管造影显示血管痉挛的比例为20.00%,低于对照组（37.7%）,差异有统计学意义（P〈0.01）;右美托咪定组患者术后发生症状性脑血管痉挛的比例为11.11%,低于对照组（26.67%）,差异有统计学意义（P〈0.01）。手术后,右美托咪定组患者大脑中动脉血流速度明显低于对照组,2组比较差异有统计学意义（P〈0.01）。结论动脉瘤性蛛网膜下腔出血围介入栓塞手术期,应用右美托咪定治疗有助于维持患者血流动力学稳定,防止继发性脑血管痉挛发生。
Objective To investigate the effects of dexmedetomidine on hemodynamics in the perioperative period of interventional embolization of aneurysmal subarachnoid hemorrhage and the occurrence of secondary cerebral vasospasm.Methods 90 cases of patients with aneurysmal subarachnoid hemorrhage who had interventional embolization surgery from October 2012 to February 2015 were randomly divided into dexmedetomidine group and a control group,45 cases in each group.Patients in both groups were given the same anesthesia induction and intravenous infusion analgesia of 2~4μg/kg of fentanyl.Patients of the control group were intermittently given 0.4~0.6mg/kg of propofol to maintain anesthesia.Patients of dexmedetomidine group were given 0.5~0.8μg/kg of dexmedetomidine within 15 minutes of anesthesia induction,0.2~0.5μg/kg·h-1 of dexmedetomidine in anesthesia maintenance and 0.1~0.2μg/kg of dexmedetomidine 10 minutes before extubation.Two groups were observed changes of mean arterial pressure（MAP）and heart rate（HR）at different time points：before operation（T0）,tracheal intubation time（T1）,before arteriocerebral angiography（T2）,10 minutes after arteriocerebral angiography（T3）,5minutes before extubation（T4）,15 minutes after extubation（T5）and they were compared their vasospasm of cerebral angiography in operation,artery blood flow velocity before and after operation and postoperative symptomatic cerebral vasospasm.Results During perioperative period,MAP and HR in patients of dexmedetomidine group had no significant change but MAP and HR in patients of the control group had significant changes.There were no significant differences of MAP and HR at T0 time point between the two groups,but the differences of MAP and HR at T1,T2,T3,and T4 time points were statistically significant（P〈0.05）.Cerebral angiography showed 20.00% of patients in dexmedetomidine group had vasospasm in operation,lower than the control group（37.7%）and the difference was statistically significant（P〈0.01）.The i
出处
《保健医学研究与实践》
2016年第1期56-58,63,共4页
Health Medicine Research and Practice
