右美托咪啶在开颅唤醒麻醉中的临床效果观察

摘要

目的 观察不同剂量的右美托咪啶在开颅唤醒麻醉中的临床效果.方法 选择行脑功能区开颅唤醒手术病人60例,随机分为低剂量组(n=20)、中剂量组(n=20)、高剂量组(n=20).所有病人在诱导前10 min给予1μg/kg右美托咪啶,静脉给予芬太尼2μg/kg、靶控输注丙泊酚待意识消失且Narcotrend分级为D2~E0级时插入喉罩.低、中、高剂量组分别在唤醒期静脉泵注右美托咪啶0.2、0.4、0.6μg/(kg?h).暴露硬脑膜后停止输注丙泊酚,并使病人在功能定位和手术过程中保持清醒.分析比较三组病人在不同时间点血流动力学变化、唤醒时间、唤醒期不良反应来评价唤醒质量.结果 高剂量组在插入喉罩时、切皮时心率低于低、中剂量组,差异具有统计学意义(P<0.05).低、中剂量组较高剂量组均能在较短时间内唤醒病人,差异具有统计学意义(P<0.05).结论 右美托咪啶可应用于脑功能区唤醒麻醉,以0.4μg/(kg?h)剂量唤醒效果最佳,可提供稳定的血流动力学,无呼吸抑制且不延长苏醒时间,是良好的脑功能区唤醒麻醉镇静药物.%Objective To investigate the clinical outcome of diffenent dosages of dexmedetomidine in awake anesthesia for craniotomy. Methods Sixty patients undergoing eloquent area operation with intraoperative awakening were randomly and equally divided into low dose group, middle dose group and high dose group. All the patients were given dose of 1 μg/kg dexmedetomidine 10 min before induction anesthesia, followed by 1 μg/kg fentanyl via intravenous administration and target conrolled infusion of proporol until the patients getting into the loss of consciousness and the Narcotrend trend of D2 to E0. Then the laryngeal mask was inserted. A continuous infusion of 0.2, 0.4, and 0.6μg/ (kg?h) dexmedetomidine via intravenous pumping was performed on patients in low, middle and high dose groups respectively. The intravenous pumping of proporol was stopped after the exposure of dura mater to make patients keep awake during the functional localization and operation. The hemodynamic changes, awakening time and adverse reaction in different time points were analyzed and compared to estimate the awakening quality of patients in the 3 groups. Results The heart rate of high dose group was lower than that of low and middle dose groups at the time of laryngeal mask insertion and the time of skin incision (P<0.05). Compared with patients in high dose group, the patients in low and middle dose groups could be aroused in a shorter time (P<0.05). Conclusions Dexmedetomidine can be applied in awake surgery. The dose of 0.4μg/ (kg?h) dexmedetomidine can obtain the best awakening quality, which provides stable hemodynamics with no respiratory depression and shorter awakening time, and thus is a good anesthesia and sedation drug for awake surgery.