中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2014年
11期
1121-1123
,共3页
右美托咪定%颅内动脉瘤夹闭术%血流动力学%氧代谢
右美託咪定%顱內動脈瘤夾閉術%血流動力學%氧代謝
우미탁미정%로내동맥류협폐술%혈류동역학%양대사
Dexmedetomidine%Intracranial aneurysm surgery%Hemodynamics%Oxygen metabolism
目的 探讨右美托咪定对颅内动脉瘤夹闭术患者脑血流动力学与氧代谢的影响.方法 选择颅内动脉瘤夹闭术患者共64例,随机分为研究组和对照组,每组各32例.研究组麻醉诱导前给右美托咪定;对照组则给予等量生理盐水,诱导及麻醉方法同研究组.观察不用时间点平均动脉压(MAP)和心率及麻醉前、插管时、动脉瘤夹闭时脑氧代谢率(CMRO2)、脑血流量(CBF)、颅内压(ICP)变化,并观察两组复苏情况.结果 研究组插管时、插管后15 min、动脉瘤夹闭时、拔管时的MAP、心率均显著低于对照组(P均<0.05).研究组插管时、动脉瘤夹闭时的CMRO2较对照组显著升高[(34.2±5.0)%与(27.1±4.2)%,(33.9±4.3)%与(26.5±3.6)%;P均<0.05],CBF较对照组显著降低[(53.5±8.8)ml/(100 g·min)与(67.3±11.2) ml/(100 g· min),(56.8±9.2) ml/(100 g· min)与(67.3±11.2)ml/(100 g·min),P均<0.05],ICP较对照组亦显著降低[(136.6±12.1) mmH2O与(168.3±15.8)mmH2O,(138.5±14.5)mmH2O与(170.4±12.1)mmH2O,P均<0.05].研究组自主呼吸恢复时间、拔管时间早于对照组[(7.35±1.12)h与(9.27±1.45)h,(12.98±3.76)h与(14.89±4.88) h;t值分别为10.92、9.23,P均<0.01],Steward评分显著高于对照组[(5.12±0.33)分与(3.98±0.28)分;t =5.55、P<0.05].结论 右美托咪定可稳定颅内动脉瘤夹闭术患者围术期血流动力学,提高脑氧摄取率,提高复苏效能,值得临床应用推广.
目的 探討右美託咪定對顱內動脈瘤夾閉術患者腦血流動力學與氧代謝的影響.方法 選擇顱內動脈瘤夾閉術患者共64例,隨機分為研究組和對照組,每組各32例.研究組痳醉誘導前給右美託咪定;對照組則給予等量生理鹽水,誘導及痳醉方法同研究組.觀察不用時間點平均動脈壓(MAP)和心率及痳醉前、插管時、動脈瘤夾閉時腦氧代謝率(CMRO2)、腦血流量(CBF)、顱內壓(ICP)變化,併觀察兩組複囌情況.結果 研究組插管時、插管後15 min、動脈瘤夾閉時、拔管時的MAP、心率均顯著低于對照組(P均<0.05).研究組插管時、動脈瘤夾閉時的CMRO2較對照組顯著升高[(34.2±5.0)%與(27.1±4.2)%,(33.9±4.3)%與(26.5±3.6)%;P均<0.05],CBF較對照組顯著降低[(53.5±8.8)ml/(100 g·min)與(67.3±11.2) ml/(100 g· min),(56.8±9.2) ml/(100 g· min)與(67.3±11.2)ml/(100 g·min),P均<0.05],ICP較對照組亦顯著降低[(136.6±12.1) mmH2O與(168.3±15.8)mmH2O,(138.5±14.5)mmH2O與(170.4±12.1)mmH2O,P均<0.05].研究組自主呼吸恢複時間、拔管時間早于對照組[(7.35±1.12)h與(9.27±1.45)h,(12.98±3.76)h與(14.89±4.88) h;t值分彆為10.92、9.23,P均<0.01],Steward評分顯著高于對照組[(5.12±0.33)分與(3.98±0.28)分;t =5.55、P<0.05].結論 右美託咪定可穩定顱內動脈瘤夾閉術患者圍術期血流動力學,提高腦氧攝取率,提高複囌效能,值得臨床應用推廣.
목적 탐토우미탁미정대로내동맥류협폐술환자뇌혈류동역학여양대사적영향.방법 선택로내동맥류협폐술환자공64례,수궤분위연구조화대조조,매조각32례.연구조마취유도전급우미탁미정;대조조칙급여등량생리염수,유도급마취방법동연구조.관찰불용시간점평균동맥압(MAP)화심솔급마취전、삽관시、동맥류협폐시뇌양대사솔(CMRO2)、뇌혈류량(CBF)、로내압(ICP)변화,병관찰량조복소정황.결과 연구조삽관시、삽관후15 min、동맥류협폐시、발관시적MAP、심솔균현저저우대조조(P균<0.05).연구조삽관시、동맥류협폐시적CMRO2교대조조현저승고[(34.2±5.0)%여(27.1±4.2)%,(33.9±4.3)%여(26.5±3.6)%;P균<0.05],CBF교대조조현저강저[(53.5±8.8)ml/(100 g·min)여(67.3±11.2) ml/(100 g· min),(56.8±9.2) ml/(100 g· min)여(67.3±11.2)ml/(100 g·min),P균<0.05],ICP교대조조역현저강저[(136.6±12.1) mmH2O여(168.3±15.8)mmH2O,(138.5±14.5)mmH2O여(170.4±12.1)mmH2O,P균<0.05].연구조자주호흡회복시간、발관시간조우대조조[(7.35±1.12)h여(9.27±1.45)h,(12.98±3.76)h여(14.89±4.88) h;t치분별위10.92、9.23,P균<0.01],Steward평분현저고우대조조[(5.12±0.33)분여(3.98±0.28)분;t =5.55、P<0.05].결론 우미탁미정가은정로내동맥류협폐술환자위술기혈류동역학,제고뇌양섭취솔,제고복소효능,치득림상응용추엄.
Objective To investigate the effects of cerebral hemodynamics and oxygen metabolism of dexmedetomidine on patients with intracranial aneurysm surgery.Methods Sixty-four patients with intracranial aneurysm surgery were collected and randomly divided into study group and control group (32 cases for each group).Patients in the study group before induction of anesthesia were given dexmedetomidine and patients in the control group were given saline but anesthesia.Mean arterial pressure (MAP),heart rate (HR),cerebral metabolic rate of oxygen(CMRO2) in different time points were observed and time in intubation and intracranial aneurysm clamp before anesthesia were rescored.Cerebral blood flow (CBF),intracranial pressure (ICP) were observed and the recovery situation.Results At the intubation,MAP and HR in the study group after 15 min of intubation,time in intracranial aneurysm clamp and extubation were significantly lower than those of the control group(P < 0.05).CMRO2 in study group at the intubation and intracranial aneurysm clamp were (34.2 ± 5.0) % and (27.1 ± 4.2),significantly higher than that of the control group ((33.9 ± 4.3) %,(26.5 ±3.6) %; P < 0.05).CBF in study group at the intubation and intracranial aneurysm clamp were (53.5 ±8.8) ml/(100 g · min) and (56.8 ±9.2) ml/(100 g · min),significantly lower than that of control group ((67.3±11.2) ml/(100 g· min),(67.3 ±11.2) ml) (100 g· min); P<0.05) ; The same trend was seen in terms of ICP.Spontaneous breathing recovery time and extubation time in study group were (7.35 ± 1.12) h and(12.98 ± 3.76),significantly earlier than those of the control group((9.27 ± 1.45) h and (14.89 ±4.88) h; t =10.92,9.23,P <0.01).Steward scores in study group was (5.12 ±0.33),significantly higher than control group ((3.98 ± 0.28) ; t =5.55,P < 0.05).Conclusion Dexmedetomidine can certainly keep hemodynamic stability in patients with intracranial aneurysm surgery,improve rate of cerebral oxygen uptake and recovery performance,which is worthy of clinical application and promotion.