Dexmedetomidine has sedative, anxiolytic, analgesic, anti-sympathetic, and anti-shivering effects. Dexmedetomidine might be effective in combination with sevoflurane for anesthesia, but prospective randomized controll...Dexmedetomidine has sedative, anxiolytic, analgesic, anti-sympathetic, and anti-shivering effects. Dexmedetomidine might be effective in combination with sevoflurane for anesthesia, but prospective randomized controlled clinical trials with which to verify this hypothesis are lacking. In total, 120 patients who underwent embolization of an intracranial aneurysm were recruited from Anhui Provincial Hospital and Renmin Hospital of Wuhan University of China and randomly allocated to two groups. After intraoperative administration of 2% to 3% sevoflurane inhalation, one group of patients received pump-controlled intravenous injection of 1.0 ~tg/kg dexmedetomidine for 15 minutes followed by maintenance with 0.3 ~tg/kg/h until the end of surgery; the other group of patients only underwent pump-controlled infusion of saline. Bispectral index monitoring revealed that dexmedetomidine-assisted anesthesia can shorten the recovery time of spon- taneous breathing, time to eye opening, and time to laryngeal mask removal. Before anesthetic induction and immediately after laryngeal mask airway removal, the glucose and lactate levels were low, the S100~ and neuron-specific enolase levels were low, the perioperative blood pressure and heart rate were stable, and postoperative delirium was minimal. These findings indicate that dexmedetomidine can effectively assist sevoflurane for anesthesia during surgical embolization of intracranial aneurysms, shorten the time to consciousness and extubation, reduce the stress response and energy metabolism, stabilize hemodynamic parameters, and reduce adverse reactions, thereby reducing the damage to the central nervous system. This trial was registered at the Chinese Clinical Trial Registry （http：//www.chictr.org. cn/） （registration number： ChiCTR-IPR- 16008113）.展开更多
目的观察芬太尼、舒芬太尼分别与瑞芬太尼联用在颅内动脉瘤栓塞手术中的应用效果。方法择期行颅内动脉瘤栓塞手术患者69例,采用随机数字表法随机分为芬太尼组（F组）、芬太尼＋瑞芬太尼组（FR组）和舒芬太尼＋瑞芬太尼组（SR组）,每组2...目的观察芬太尼、舒芬太尼分别与瑞芬太尼联用在颅内动脉瘤栓塞手术中的应用效果。方法择期行颅内动脉瘤栓塞手术患者69例,采用随机数字表法随机分为芬太尼组（F组）、芬太尼＋瑞芬太尼组（FR组）和舒芬太尼＋瑞芬太尼组（SR组）,每组23例。所有患者均采用全凭静脉全身麻醉,麻醉诱导：F组和FR组患者静脉注射3μg·kg-1芬太尼,SR组患者静脉注射0.5μg·kg-1舒芬太尼,余依次静脉注射咪达唑仑、丙泊酚、顺苯磺酸阿曲库铵,插管后行间歇正压通气,并调整呼吸参数维持呼气末二氧化碳分压（PETCO2）在30~35 mm Hg（1 mm Hg=0.133 k Pa）。麻醉维持：3组患者均采用微量泵持续泵注丙泊酚6~8 mg·kg-1·h-1、顺苯磺酸阿曲库铵0.1 mg·kg-1·h-1,同时FR组和SR组患者持续泵注瑞芬太尼0.2μg·kg-1·min-1,手术结束前5 min停用顺苯磺酸阿曲库铵、丙泊酚,瑞芬太尼输注至手术结束时,诱导后每60 min F组、FR组患者静脉注射0.1 mg芬太尼,SR组患者静脉注射5μg舒芬太尼。监测麻醉诱导前（T0）、麻醉诱导后（T1）、气管插管后1 min（T2）、术中1 h（T3）、拔管后1（T4）、5 min（T5）时的平均动脉压（MAP）及心率（HR）。记录患者呼吸恢复时间、苏醒时间、拔管时间及拔管后1 min、拔管后10 min时的警觉/镇静（OAA/S）评分,观察不良反应发生情况。结果 3组患者T0时MAP、HR比较差异均无统计学意义（P〉0.05）。F组患者T1时MAP、HR较T0时降低,T2、T4时MAP、HR较T0时增高（P〈0.05）;FR组患者T1、T3时MAP、HR较T0时降低,T2、T4时MAP、HR较T0时增高（P〈0.05）;SR组患者T1、T2、T3、T4时MAP、HR均较T0时降低（P〈0.05）。FR组患者T3时及SR组患者T2、T3、T4时MAP、HR较F组同时点降低（P〈0.05）。SR组患者T2、T4时MAP、HR比FR组同时点显著降低（P〈0.05）。3组患者呼吸恢复时间及拔管后1、10 min OAA/S评分比较差异均无统计学意义�展开更多
目的评价多巴胺静脉泵注在颅内动脉瘤栓塞术麻醉中的效果。方法择期行颅内动脉瘤栓塞术的ASA分级Ⅱ~Ⅲ级患者40例,随机分为多巴胺组和对照组,每组20例。多巴胺组术中静脉泵注多巴胺2~4μg/（kg？min）,对照组静脉泵注同等容量生理盐水...目的评价多巴胺静脉泵注在颅内动脉瘤栓塞术麻醉中的效果。方法择期行颅内动脉瘤栓塞术的ASA分级Ⅱ~Ⅲ级患者40例,随机分为多巴胺组和对照组,每组20例。多巴胺组术中静脉泵注多巴胺2~4μg/（kg？min）,对照组静脉泵注同等容量生理盐水。每组以丙泊酚静脉泵注4 mg/（kg？h）,瑞芬太尼6μg/（kg？h）麻醉维持,术中静脉泵注尼莫地平2~4μg/（kg？min）,并维持平均动脉压60~75 mm Hg。观察两组麻醉医师暴露在放射线下的时间,麻醉时间及拔管时间。结果多巴胺组术中麻醉医师暴露在放射线下的时间明显少于对照组（P〈0.05）,两组麻醉时间及拔管时间无显著差异（P〉0.05）。结论多巴胺静脉泵注用于颅内动脉瘤栓塞术麻醉,血流动力学更平稳,能减少麻醉医师暴露在放射线下的时间。展开更多
基金supported by the National Natural Science Foundation of China,No.81671891
文摘Dexmedetomidine has sedative, anxiolytic, analgesic, anti-sympathetic, and anti-shivering effects. Dexmedetomidine might be effective in combination with sevoflurane for anesthesia, but prospective randomized controlled clinical trials with which to verify this hypothesis are lacking. In total, 120 patients who underwent embolization of an intracranial aneurysm were recruited from Anhui Provincial Hospital and Renmin Hospital of Wuhan University of China and randomly allocated to two groups. After intraoperative administration of 2% to 3% sevoflurane inhalation, one group of patients received pump-controlled intravenous injection of 1.0 ~tg/kg dexmedetomidine for 15 minutes followed by maintenance with 0.3 ~tg/kg/h until the end of surgery; the other group of patients only underwent pump-controlled infusion of saline. Bispectral index monitoring revealed that dexmedetomidine-assisted anesthesia can shorten the recovery time of spon- taneous breathing, time to eye opening, and time to laryngeal mask removal. Before anesthetic induction and immediately after laryngeal mask airway removal, the glucose and lactate levels were low, the S100~ and neuron-specific enolase levels were low, the perioperative blood pressure and heart rate were stable, and postoperative delirium was minimal. These findings indicate that dexmedetomidine can effectively assist sevoflurane for anesthesia during surgical embolization of intracranial aneurysms, shorten the time to consciousness and extubation, reduce the stress response and energy metabolism, stabilize hemodynamic parameters, and reduce adverse reactions, thereby reducing the damage to the central nervous system. This trial was registered at the Chinese Clinical Trial Registry （http：//www.chictr.org. cn/） （registration number： ChiCTR-IPR- 16008113）.
文摘目的观察芬太尼、舒芬太尼分别与瑞芬太尼联用在颅内动脉瘤栓塞手术中的应用效果。方法择期行颅内动脉瘤栓塞手术患者69例,采用随机数字表法随机分为芬太尼组（F组）、芬太尼＋瑞芬太尼组（FR组）和舒芬太尼＋瑞芬太尼组（SR组）,每组23例。所有患者均采用全凭静脉全身麻醉,麻醉诱导：F组和FR组患者静脉注射3μg·kg-1芬太尼,SR组患者静脉注射0.5μg·kg-1舒芬太尼,余依次静脉注射咪达唑仑、丙泊酚、顺苯磺酸阿曲库铵,插管后行间歇正压通气,并调整呼吸参数维持呼气末二氧化碳分压（PETCO2）在30~35 mm Hg（1 mm Hg=0.133 k Pa）。麻醉维持：3组患者均采用微量泵持续泵注丙泊酚6~8 mg·kg-1·h-1、顺苯磺酸阿曲库铵0.1 mg·kg-1·h-1,同时FR组和SR组患者持续泵注瑞芬太尼0.2μg·kg-1·min-1,手术结束前5 min停用顺苯磺酸阿曲库铵、丙泊酚,瑞芬太尼输注至手术结束时,诱导后每60 min F组、FR组患者静脉注射0.1 mg芬太尼,SR组患者静脉注射5μg舒芬太尼。监测麻醉诱导前（T0）、麻醉诱导后（T1）、气管插管后1 min（T2）、术中1 h（T3）、拔管后1（T4）、5 min（T5）时的平均动脉压（MAP）及心率（HR）。记录患者呼吸恢复时间、苏醒时间、拔管时间及拔管后1 min、拔管后10 min时的警觉/镇静（OAA/S）评分,观察不良反应发生情况。结果 3组患者T0时MAP、HR比较差异均无统计学意义（P〉0.05）。F组患者T1时MAP、HR较T0时降低,T2、T4时MAP、HR较T0时增高（P〈0.05）;FR组患者T1、T3时MAP、HR较T0时降低,T2、T4时MAP、HR较T0时增高（P〈0.05）;SR组患者T1、T2、T3、T4时MAP、HR均较T0时降低（P〈0.05）。FR组患者T3时及SR组患者T2、T3、T4时MAP、HR较F组同时点降低（P〈0.05）。SR组患者T2、T4时MAP、HR比FR组同时点显著降低（P〈0.05）。3组患者呼吸恢复时间及拔管后1、10 min OAA/S评分比较差异均无统计学意义�
文摘目的评价多巴胺静脉泵注在颅内动脉瘤栓塞术麻醉中的效果。方法择期行颅内动脉瘤栓塞术的ASA分级Ⅱ~Ⅲ级患者40例,随机分为多巴胺组和对照组,每组20例。多巴胺组术中静脉泵注多巴胺2~4μg/（kg？min）,对照组静脉泵注同等容量生理盐水。每组以丙泊酚静脉泵注4 mg/（kg？h）,瑞芬太尼6μg/（kg？h）麻醉维持,术中静脉泵注尼莫地平2~4μg/（kg？min）,并维持平均动脉压60~75 mm Hg。观察两组麻醉医师暴露在放射线下的时间,麻醉时间及拔管时间。结果多巴胺组术中麻醉医师暴露在放射线下的时间明显少于对照组（P〈0.05）,两组麻醉时间及拔管时间无显著差异（P〉0.05）。结论多巴胺静脉泵注用于颅内动脉瘤栓塞术麻醉,血流动力学更平稳,能减少麻醉医师暴露在放射线下的时间。
