盐酸右美托咪啶辅助全身麻醉在神经胶质瘤手术中的应用

摘要

目的：评价盐酸右美托咪啶（dexmedetomidine, Dex）作为全身麻醉辅助用药对神经胶质瘤患者围术期血流动力学的影响。方法本研究采用前瞻性随机双盲对照设计，选择择期行胶质瘤切除术患者30例，年龄40岁～60岁，体重在45 kg～80 kg，美国麻醉医师协会（ASA）分级Ⅱ～Ⅲ级，采用随机数字表法，将患者随机分为2组（每组15例）：生理盐水对照组（C组），盐酸右美托咪啶组（D组），D于常规诱导前10 min静脉输注Dex负荷量1μg/kg，继之分别以0.5μg·kg-1·h-1持续输注至术毕前30 min，C组给与等容量的生理盐水。2组术中维持脑电双频指数值(bispectral index, BIS)在40～49之间，分别于麻醉诱导前（T1），开颅时（T2），插管时（T3），拔管时（T4）采集血流动力学数据，记录拔管时间和芬太尼使用量，且分别于T1、T2、T3、T4采集桡动脉及颈静脉球部的血样行血气分析，记录并计算脑氧摄取率（cerebral extraction of O2, CEO2）。结果与C组比较，D组在T2-T4时血压及心率较低，脑氧摄取率升高，差异有统计学意义。与C组比较，D组芬太尼的使用量降低，拔管时间缩短，差异有统计学意义。结论围术期持续输注Dex可稳定围术期血流动力学，升高神经胶质瘤患者CEO2，降低围术期芬太尼的使用量，缩短拔管时间，发挥脑保护作用。%Objective To evaluate the effect of dexmedetomidine (Dex) as general anesthesia drugs for gliomas patients in hemodynamic. Methods Prospective, randomly and double-blind design was chosen for this study, 30 cases of elective glioma patients were selected who aged between 40 to 60 years old, weighed between 45 to 80 kg, ASA divided intoⅡtoⅢlevel, random number method was selected, patients were divided into 2 groups(each group was 15 cases):the control group(the C group), dexmedetomidine HCL(the D group), the D group gave the drugs by intravenous Dex 1μg/kg before conventional induction 10 min, and continued by the speed of 0.5μg·kg-1·h-1 in first 30min, the C group gave same amount of saline. Bispectral index were maintained between 40-49 of two groups, and data of intuction (T1), craniotomy (T2), intubation (T3) and extubation (T4) were collected, extubation time and usage of fentanyl were collected, and the data of T1, T2, T3 and T4 were analyzed, the rate of CEO2 were collected. Results The blood pressure and the rate of heart and uptake ratio of brain oxygen in the D group were lower than that of the C group around T2 to T4, there is significant difference. The usage of fentanyl in the D group is lower than that of the C group, extubation is lower as well, there is significant difference. Conclusion CContinuous infusion of Dex can stable hemodynamic, CEO2 of gliomas patients can increase, the usage of fantanyl can decrease, extubation can decrease, for neuroprotection.