右美托咪定复合丙泊酚和瑞芬太尼用于脑动脉瘤夹闭术患者麻醉的效果分析

摘要

目的 评价右美托咪定复合丙泊酚和瑞芬太尼用于脑动脉瘤夹闭术患者麻醉的效果.方法 选取2014年2月至2015年1月于内蒙古医科大学附属医院拟全身麻醉下行脑动脉瘤夹闭术患者60例,采用随机数字表法分为右美托咪定组和对照组,各30例.麻醉诱导前右美托咪定组于10 min内静脉泵注右美托咪定负荷剂量1.0 μg/kg,随后以0.4μg/(kg·h)维持剂量静脉泵注至拔除气管导管;对照组静脉输注等容量0.9％氯化钠注射液.2组均靶控输注丙泊酚和瑞芬太尼、静脉输注罗库溴铵进行麻醉诱导.比较2组患者气管导管插管前(T1)、气管导管插管后(T2)、气管导管拔除前(T3)和气管导管拔除后(T4)各时点的心率和平均动脉压(MAP),术中瑞芬太尼、罗库溴铵和丙泊酚的用量,气管导管拔除时间和苏醒时间,术中和麻醉恢复期不良反应发生情况.结果 右美托咪定组T1、T2、T3、T4时点的MAP分别为(92±10)、(94±11)、(93±9)、(95±10)mmHg(1 mmHg =0.133 kPa),心率分别为(72±11)、(71±10)、(74±10)、(76±11)次/min;对照组T1、T2、T3、T4时点的MAP分别为(110±9)、(127±12)、(109±11)、(125±12) mmHg,心率分别为(77±11)、(93±12)、(79±13)、(113±13)次/min.右美托咪定组各时点的MAP和心率均明显低于对照组,差异有统计学意义(P＜0.05).右美托咪定组丙泊酚用量少于对照组[(1 058±471) mg比(1 410±420)mg],苏醒时间长于对照组[(36±6) min比(13±5)min],差异有统计学意义(P＜0.05).2组瑞芬太尼和罗库溴铵用量差异无统计学意义(P＞0.05).右美托咪定组术中心动过速、高血压和麻醉恢复期烦躁、呕吐、心动过速、高血压的发生率均明显低于对照组[0.0％ (0/30)比13.3％(4/30)、3.3％(1/30)比26.7％(8/30)、10.0％(3/30)比66.7％(20/30)、0.0％(0/30)比10.0％ (3/30)、6.7％(2/30)比90.0％(27/30)、13.3％ (4/30)比83.3％ (25/30)],差异均有统计学意义(均P＜0.05).结论 右美托咪定复合丙泊酚和瑞芬太尼可有效抑制脑动脉瘤夹闭术中气管导管插管期和拔管期的心血管反应,麻醉效果好,血流动力稳定性较佳.%Objective To evaluate the anesthesia efficacy of dexmedetomidine combined with propofol and remifentanil in patients undergoing cerebral aneurysm clamping surgery.Methods Sixty patients undergoing cerebral aneurysm clamping surgery from February 2014 to January 2015 were randomly divided into dexmedetomidine group (30 cases) and control group (30 groups).Dexmedetomidine was injected before anesthesia induction with a loading dose of 1.0 μg/kg (10 min) followed by 0.4 μg/(kg · h) till extubation in dexmedetomidine group;the same volume of 0.9％ sodium chloride was injected in control group.Anesthesia induction was performed by target controlled infusion of propofol, remifentanil and intravenous infusion of rocuronium in both groups.The heart rate and mean arterial pressure (MAP) before and after intubation (T1 and T2), before and after extubation (T3 and T4) were monitored;doses of remifentanil, rocuronium and propofol, the time of extubation and anesthesia recovery, the complications during operation and anesthesia recovery period were recorded.Results The MAP and heart rate were significantly lower/slower in dexmedetomidine group than those in control group at T1 [(92 ± 10) mmHg vs (110 ± 9) mmHg, (72 ± 11) times/min vs (77 ± 11) times/min], T2 [(94 ± 1 1) mmHg vs (127 ± 12) mmHg, (71 ±10) times/min vs (93 ± 12) times/min], T3 [(93-9) mmHg vs (109 ± 11) mmHg, (74 ± 10) times/min vs (79±13) times/min], and T4 [(95 ± 10) mmHg vs (125 ± 12) mmHg, (76 ± 11) times/min vs (113 ± 13) times/min] (P ＜ 0.05).The amount of propofol consumed was significantly less in dexmedetomidine group compared with that in control group [(1 058 ±471) mg vs(1 410 ±420) mg] and the time of anesthesia recovery in dexmedetomidine group was significantly prolonged compared with that in control group [(36 ± 6) min vs (13 ±5) min] (P ＜ 0.05).The usages of remifentanil and rocuronium had no significant differences between groups (P ＞0.05).The incidences of hypertension and tachycardia during operation, the incidences of restlessness, vomitting, hypertension, tachycardia during anesthesia recovery period in dexmedetomidine group were significantly lower than those control group [3.3％ (1/30) vs 26.7％ (8/30) ,0.0％ (0/30) vs 13.3％ (4/30) , 10.0％ (3/30) vs 66.7％ (20/30) ,0.0％ (0/30) vs 10.0％ (3/30), 13.3％ (4/30) vs 83.3％ (25/30) ,6.7％ (2/30) vs 90.0％ (27/30)] (P ＜ 0.05).Conclusion Dexmedetomidine combined with propofol and remifentanil can effectively reduce the cardiovascular response during intubation and extubation in patients undergoing cerebral aneurysm clamping surgery, which provides satisfactory efficacy and maintains good hemodynamic stability.