右美托咪定辅助全麻在面肌痉挛患者手术中的临床应用研究

摘要

目的：研究右美托咪定辅助全麻在面肌痉挛患者手术中的临床应用。方法选择面肌痉挛手术患者40例，使用DAS软件将患者随机分成2组（n＝20）：对照组（C组）和右美托咪定组（Dex组）。 Dex组在常规麻醉用药前10 min经静脉输注右美托咪定1μg／kg，随后以0．5μg· kg－1· h－1的速率静脉输注至手术结束；C组在常规全麻时给予等量的生理盐水。于手术开始前即刻（T0）、术中面神经与血管分离时（T1）、手术结束后即刻（T2）抽取患者静脉血，检测各时间点患者血中去甲肾上腺素（NE）、血浆皮质醇（Cor）、C反应蛋白（CRP）及血糖的浓度，同时观察各组平均动脉压（MAP）、心率（HR）及脉搏血氧饱和度（SpO2）的变化。并于T0、T2、手术结束后12 h（T3）和手术结束后24 h（T4）抽取静脉血，检测各时间点患者血清神经元特异性烯醇化酶（NSE）、S－100β蛋白浓度。结果 DEX组与对照组相比，在T0、T1及 T2组间 HR、MAP的差异有统计学意义（P＜0．05），而SpO2的差异无统计学意义（P＞0．05）；在T1及T2组间Cor、NE、CRP及血糖浓度的差异有统计学意义（P＜0．05）；在T2、T3、T4时DEX组较对照组S－100β、NSE浓度明显下降，差异有统计学意义（ P＜0．05）。结论常规麻醉前静脉输注右美托咪定1μg／kg，随后以0．5μg· kg－1· h－1的速率静脉输注至手术结束，对面肌痉挛手术患者的血流动力学影响小，可明显抑制患者的应激反应，降低患者血清中NSE与S－100β蛋白浓度，具有一定的脑保护作用，是适用于面肌痉挛患者手术的一种简单、安全、有效的辅助麻醉方法。%Objective To investigate the application of dexmedetomidine for general anesthesia in hemifacial spasm surgery.Methods A total of 40 patients with hemifacial spasm were randomly divided into two groups ( n=20):a con-trol group ( Group C) and a dexmedetomidine group ( Group Dex) .Patients in Group Dex was intravenously infused with 1 μg/kg dexmedetomidine over 10 min before routine general anesthesia, followed by infusion at a rate of 0.5μg · kg-1 · h-1 until the end of operation.In contrast, Group C was administrated with the equal volume of normal saline during routine general anesthesia.Intravenous blood samples were collected immediately before surgery ( T0 ) , when the facial nerve and vessels were separated during operation (T1), and immediately after surgery (T2) to measure the serum con-centrations of cortisol ( Cor ) , C-reactive protein ( CRP ) , blood glucose ( GLU ) and norepinephrine ( NE ) in each group.Meanwhile, the changes in mean arterial pressure (MAP), heart rate (HR) and oxygen saturation (SpO2) of each group were observed.Intravenous blood samples were collected at T0, T2, 12 hours after surgery ( T3) and 24 hours after surgery ( T4) to measure the serum concentrations of neuron-specific enolase ( NSE) and S-100β.Results Compared with the control group, the DEX group showed significant difference at T0, T1 and T2 in HR and MAP (P<0.05), rather than SpO2(P>0.05).Compared with the control group, the DEX group showed significant difference at T1 and T2 in Cor, GLU and NE (P<0.05).Compared with the control group, the DEX group showed remarkable de-creases in the concentration of S-100βand NSE (P<0.05) at T2, T3 and T4.Conclusions Intravenous infusion of 1.0 μg/kg dexmedetomidine before routine general anesthesia followed by infusion at a rate of 0.5μg· kg-1 · h-1 until the end of operation has less effects on the hemodynamics of patients in hemifacial spasm surgery.It can significantly re-duce patients′stress response and lower the serum concentration of S-100βand NSE, and protect the brain, which is a simple, safe and effective anesthesia method in hemifacial spasm surgery.