摘要
目的探讨右美托咪定对颅内动脉瘤栓塞患者麻醉恢复质量的影响。方法选择ASA分级Ⅰ或Ⅱ级、Hunt⁃Hess分级0或Ⅰ级,择期行颅内动脉瘤栓塞的患者140例,采用随机数字表法分为3组:右美托咪定滴鼻组(A组,45例),患者在麻醉诱导前10 min给予右美托咪定0.5μg/kg滴鼻;右美托咪定静脉组(B组,47例),患者从麻醉诱导前10 min开始至手术结束持续静脉输注右美托咪定0.4μg·kg^(−1)·h^(−1);空白对照组(C组,48例),不给予右美托咪定。记录苏醒期患者咳嗽分级和Ricker镇静⁃躁动评分,麻醉诱导前(T_(0))、插管前(T_(1))、插管即刻(T_(2))、插管后1 min(T_(3))、动脉瘤栓塞前(T4)、栓塞结束(T_(5))、呼之睁眼时(T_(6))、拔管时(T_(7))和拔管后2 min(T_(8))时MAP和心率变化,术中丙泊酚及瑞芬太尼用量,停药至拔管时间,动脉瘤栓塞前后血糖和乳酸值,术前24 h和术后24 h简易智力状态检查量表(Mini⁃Mental State Examination,MMSE)评分以及苏醒期缺氧(SpO_(2)<90%)、喉痉挛等并发症发生情况。结果与C组比较,B组苏醒期呛咳和躁动发生率降低(P<0.05),A组差异无统计学意义(P>0.05)。与T_(0)时比较,A组T_(1)、T_(3)、T_(4)、T_(5)时和B组T_(1)、T_(3)、T_(4)时MAP均降低(P<0.05),3组患者各时点心率差异无统计学意义(P>0.05);与T_(5)时比较,A组和C组T_(6)、T_(7)、T_(8)时MAP明显升高,T_(7)、T_(8)时心率明显升高(P<0.05),B组MAP和心率差异无统计学意义(P>0.05);与B组比较,A组和C组T_(8)时心率较高(P<0.05);3组患者T_(6)、T_(7)、T_(8)时MAP比较差异无统计学意义(P>0.05)。3组患者丙泊酚及瑞芬太尼维持用量、停药至拔管时间、术前24 h和术后24 h MMSE评分比较差异均无统计学意义(P>0.05)。与栓塞前比较,A组和B组栓塞后血糖差异无统计学意义(P>0.05),C组栓塞结束时血糖指标有所升高,差异有统计学意义(P<0.05);与栓塞前比较,3组栓塞后乳酸差异均无统计学意义(P>0.05)。3
Objective To investigate the effects of dexmedetomidine on the recovery quality of patients undergoing intracranial aneurysm embolization.Methods A total of 140 patients,American Society of Anesthesiologists(ASA)gradeⅠorⅡ,Hunt‑Hess grades 0 orⅠ,who were scheduled for intracranial aneurysm embolization were enrolled.According to the random number table method,they were randomly divided into three groups:a nasal dexmedetomidine group(group A,n=45,which was nasally administered with 0.5μg/kg of dexmedetomidine 10 min before anesthesia induction),an intravenous dexmedetomidine group(group B,n=47,which was intravenously infused with dexmedetomidine at a rate of 0.4μg·kg^(−1)·h^(−1),10 min before anesthesia induction until the end of surgery),and a blank control group(group C,n=48,without administration of dexmedetomidine).The Ricker's sedation‑agitation score and the grade of cough during the recovery period were recorded.The mean arterial pressure(MAP)and heart rate were determined before anesthesia induction(T_(0)),before intubation(T_(1)),after intubation(T_(2)),1 min after intubation(T_(3)),before aneurysm embolization(T4),at the end of embolization(T_(5)),when the eyes opened(T_(6)),at extubation(T_(7)),and 2 min after extubation(T_(8)).The intraoperative dosage of propofol and remifentanil,the time from withdrawal to extubation,the levels of blood glucose and lactic acid before and after embolization of the aneurysms,the Mini‑Mental State Examination(MMSE)24 h before and 24 h after surgery and complications like hypoxia[pulse oxygen saturation(SpO_(2))<90%]and laryngospasm during the recovery period were recorded.Results Compared with group C,group B presented decreases in the incidence of cough and agitation during the recovery period(P<0.05),while no significant difference was found in group A(P>0.05).Compared with those at T_(0),decreases in MAP were found in group A at T_(1)、T_(3)、T_(4) and T_(5),and in group B at T_(1),T_(3) and T4(P<0.05),while no statistical difference was found in
作者
李岩
王小慧
张久祥
白晓光
路志红
Li Yan;Wang Xiaohui;Zhang Jiuxiang;Bai Xiaoguang;Lu Zhihong(Department of Anesthesia and Perioperative Medicine,Xijing Hospital,Air Force Military Medical University,Xi'an 710032,China)
出处
《国际麻醉学与复苏杂志》
CAS
2021年第6期578-583,共6页
International Journal of Anesthesiology and Resuscitation
基金
国家自然科学基金(81871028,81701207)
陕西省科技重大专项一般项目(2018SF⁃277)
“人福”青年麻醉学医师科研基金(21800007)。
关键词
右美托咪定
颅内动脉瘤
栓塞术
麻醉恢复期
Dexmedetomidine
Intracranial aneurysm
Embolization
Anesthesia recovery period
