中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2015年
1期
30-32
,共3页
右美托眯啶%颅脑损伤%麻醉,全身
右美託瞇啶%顱腦損傷%痳醉,全身
우미탁미정%로뇌손상%마취,전신
Dexmedetomidine%Craniocerebral trauma%Anesthesia,general
目的 评价右美托咪定对颅脑损伤患者全麻下开颅术时的脑保护作用.方法 拟在全麻下行开颅术的颅脑损伤患者60例,性别不限,年龄30～50岁,体重指数18～25 kg/m2,ASA分级Ⅱ或Ⅲ级,格拉斯哥昏迷计分法评分6～12分,采用随机数字表法,将其分为2组(n=30):对照组(C组)和右美托咪定组(Dex组).Dex组于常规麻醉诱导用药前经10 min静脉输注右美托咪定1 μg/kg,随后以0.5 μg· kg-1·h-1输注至术毕,C组给予等容量生理盐水.于手术开始前即刻(T0)、切开硬脑膜即刻(T1)、手术开始后2h(T2)、缝合硬脑膜(T3)和手术结束(T4)时采集桡动脉和颈内静脉球部血样,进行血气分析,计算动脉-静脉血氧含量差和脑氧摄取率;采用ELISA法测定血清S-100β蛋白浓度.结果 与T0时比较,2组T2-4时血清S-100β蛋白浓度升高(P＜0.05);与C组比较,Dex组T2-4时血清S-100β蛋白浓度降低(P＜0.05);2组脑氧代谢指标均在正常范围.结论 常规麻醉诱导前静脉输注右美托眯定1 μg/kg,随后以0.5 μg·kg-1 h-1输注至术毕对颅脑损伤患者全麻下开颅术时产生一定的脑保护作用.
目的 評價右美託咪定對顱腦損傷患者全痳下開顱術時的腦保護作用.方法 擬在全痳下行開顱術的顱腦損傷患者60例,性彆不限,年齡30～50歲,體重指數18～25 kg/m2,ASA分級Ⅱ或Ⅲ級,格拉斯哥昏迷計分法評分6～12分,採用隨機數字錶法,將其分為2組(n=30):對照組(C組)和右美託咪定組(Dex組).Dex組于常規痳醉誘導用藥前經10 min靜脈輸註右美託咪定1 μg/kg,隨後以0.5 μg· kg-1·h-1輸註至術畢,C組給予等容量生理鹽水.于手術開始前即刻(T0)、切開硬腦膜即刻(T1)、手術開始後2h(T2)、縫閤硬腦膜(T3)和手術結束(T4)時採集橈動脈和頸內靜脈毬部血樣,進行血氣分析,計算動脈-靜脈血氧含量差和腦氧攝取率;採用ELISA法測定血清S-100β蛋白濃度.結果 與T0時比較,2組T2-4時血清S-100β蛋白濃度升高(P＜0.05);與C組比較,Dex組T2-4時血清S-100β蛋白濃度降低(P＜0.05);2組腦氧代謝指標均在正常範圍.結論 常規痳醉誘導前靜脈輸註右美託瞇定1 μg/kg,隨後以0.5 μg·kg-1 h-1輸註至術畢對顱腦損傷患者全痳下開顱術時產生一定的腦保護作用.
목적 평개우미탁미정대로뇌손상환자전마하개로술시적뇌보호작용.방법 의재전마하행개로술적로뇌손상환자60례,성별불한,년령30～50세,체중지수18～25 kg/m2,ASA분급Ⅱ혹Ⅲ급,격랍사가혼미계분법평분6～12분,채용수궤수자표법,장기분위2조(n=30):대조조(C조)화우미탁미정조(Dex조).Dex조우상규마취유도용약전경10 min정맥수주우미탁미정1 μg/kg,수후이0.5 μg· kg-1·h-1수주지술필,C조급여등용량생리염수.우수술개시전즉각(T0)、절개경뇌막즉각(T1)、수술개시후2h(T2)、봉합경뇌막(T3)화수술결속(T4)시채집뇨동맥화경내정맥구부혈양,진행혈기분석,계산동맥-정맥혈양함량차화뇌양섭취솔;채용ELISA법측정혈청S-100β단백농도.결과 여T0시비교,2조T2-4시혈청S-100β단백농도승고(P＜0.05);여C조비교,Dex조T2-4시혈청S-100β단백농도강저(P＜0.05);2조뇌양대사지표균재정상범위.결론 상규마취유도전정맥수주우미탁미정1 μg/kg,수후이0.5 μg·kg-1 h-1수주지술필대로뇌손상환자전마하개로술시산생일정적뇌보호작용.
Objective To evaluate the cerebral protection of dexmedetomidine during craniotomy under general anesthesia in the patients with craniocerebral injury.Methods Sixty patients with craniocerebral injury,aged 30-50 yr,with body mass index of 18-25 kg/m2,of ASA physical status Ⅱ or Ⅲ,with Glasgow Coma Scale score of 6-12,scheduled for elective craniotomy under general anesthesia,were randomized into 2 groups (n =30 each) using a random number table:control group (group C) and dexmedetomidine group (group Dex).Anesthesia was induced with iv midazolam,propofol,cisatracurium and sufentanil.The patients were endotracheally intubated and mechanically ventilated.In group Dex,dexmedetomidine 1 μg/kg was infused intravenously over 10 min before induction of anesthesia,followed by infusion at a rate of 0.5 μg · kg-1 · h-1 until the end of operation.The equal volume of normal saline was given in group C.Immediately before beginning of surgery (T0),at the moment when the duramater was opened (T1),at 2 h after beginning of surgery (T2),at the duramater closing (T3) and at the end of surgery (T4),blood samples were obtained from the radial artery and jugular venous bulb for blood gas analysis,arteriovenous blood O2 difference and cerebral O2 extraction rate were calculated.The serum concentrations of S-100β were measured by ELISA.Results The serum concentrations of S-100β were significantly increased at T2-4 than at T0 in both groups.The serum concentrations of S-100β were significantly decreased at T2-4 in group Dex than in group C.The parameters of cerebral oxygen metabolism were all within the normal range in both groups.Conclusion Dexmedetomidine (1 μg/kg infused intravenously before induction of anesthesia,followed by infusion at a rate of 0.5 μg · kg-1 · h-1 until the end of operation) provides cerebral protection to some extent during craniotomy under general anesthesia in the patients with craniocerebral injury.
