高级检索

右美托咪定在动脉瘤性蛛网膜下腔出血介入手术麻醉中的临床应用

李斌本, 王薇, 汪惠, 文平山

李斌本, 王薇, 汪惠, 等. 右美托咪定在动脉瘤性蛛网膜下腔出血介入手术麻醉中的临床应用[J]. 中国临床医学, 2019, 26(3): 462-466. DOI: 10.12025/j.issn.1008-6358.2019.20190144
引用本文: 李斌本, 王薇, 汪惠, 等. 右美托咪定在动脉瘤性蛛网膜下腔出血介入手术麻醉中的临床应用[J]. 中国临床医学, 2019, 26(3): 462-466. DOI: 10.12025/j.issn.1008-6358.2019.20190144
et alClinical application of dexmedetomidine in anesthesia for interventional surgery of aneurysmal subarachnoid hemorrhage[J]. Chin J Clin Med, 2019, 26(3): 462-466. DOI: 10.12025/j.issn.1008-6358.2019.20190144
Citation: et alClinical application of dexmedetomidine in anesthesia for interventional surgery of aneurysmal subarachnoid hemorrhage[J]. Chin J Clin Med, 2019, 26(3): 462-466. DOI: 10.12025/j.issn.1008-6358.2019.20190144

右美托咪定在动脉瘤性蛛网膜下腔出血介入手术麻醉中的临床应用

Clinical application of dexmedetomidine in anesthesia for interventional surgery of aneurysmal subarachnoid hemorrhage

  • 摘要: 目的:探讨动脉瘤性蛛网膜下腔出血(aSAH)介入手术麻醉中右美托咪定的应用对患者血流动力学、应激反应和继发性脑血管痉挛(CVS)发生率的影响。方法:2017年4月至2018年6月,在本院行介入治疗的120例aSAH患者按是否应用右美托咪定分为两组:D组(是,n=60)、C组(否,n=60)。比较两组患者手术情况、血流动力学、应激反应、CVS发生率及预后。结果:麻醉诱导后(T1)~术毕(T4),两组患者平均动脉压(MAP)、心率(HR)水平较麻醉诱导前(T0)均有不同程度下降,拔管时(T5)呈上升趋势,但D组T1~气管插管后5 min(T3)的MAP水平、T1~T5时间点的HR均高于C组(P<0.05)。较麻醉诱导前,术毕、术毕6 h及术毕24 h时两组患者中性粒细胞计数(PMN)、丙二醛(MDA)水平上升,超氧化物歧化酶(SOD)下降;但D组患者各时间点PMN、MDA低于C组,SOD活性高于C组(P<0.05)。D组患者血管造影痉挛、症状性脑血管痉挛发生率均低于C组(P<0.05)。两组患者住院时间比较差异无统计学意义;但D组患者中GOS评分1~3分比重显著低于C组(P<0.05 )。结论:aSAH介入手术麻醉中右美托咪定的应用可改善血流动力学、降低应激反应,有利于减少CVS发生。
    Abstract: Objective:To analyze the effects of dexmedetomidine on hemodynamics, stress response, and incidence rate of secondary cerebral vasospasm (CVS) in anesthesia for interventional surgery of aneurysmal subarachnoid hemorrhage (aSAH). Methods:A total of 120 patients with aSAH undergoing interventional therapy in the hospital from April 2017 to June 2018 were divided into group D (use, n=60) and group C (no use, n=60) according to whether using the dexmedetomidine. The surgical conditions, hemodynamics, stress response, incidence rate of CVS, and prognosis were compared between the two groups. Results:The levels of mean arterial pressure (MAP) and heart rate (HR) in the two groups after anesthesia induction (T1) to the end of surgery (T4) were decreased compared with those before anesthesia induction (T0), and the two parameters showed increasing trends during extubation (T5), but the MAP level from T1 to T5 after tracheal intubation (T3) and the HR level at T1 to T5 time points in group D were significantly higher than those in group C (P<0.05). The neutrophil count (PMN) and malondialdehyde (MDA) in the two groups were increased, while superoxide dismutase (SOD) was decreased significantly at the end of surgery, 6 h and 24 h after surgery than before anesthesia induction. But the PMN and MDA in group D were lower than those in group C at each time point while the activities of SOD were higher than that in group C (P<0.05). The incidence rates of angiographically-confirmed vasospasm and symptomatic cerebral vasospasm in group D were significantly lower than those in group C (P<0.05). There was no significant difference in the hospital stay between the two groups. The proportion of GOS score of 1 to 3 points in group D was significantly lower than that in group C(P<0.05). Conclusions:Dexmedetomidine in interventional operation of aSAH can improve hemodynamics and reduce stress response and the incidence rate of CVS.
  • [1] Storrow A B , Wrenn K , Gans K D , et al. Aneurysmal Subarachnoid Hemorrhage[J]. NEW ENGL J MED, 2017, 354(16):1755-7.
    [2] Rosalind L P M , Rose D , Jinglu A . Association between S100B Levels and Long-Term Outcome after Aneurysmal Subarachnoid Hemorrhage: Systematic Review and Pooled Analysis[J]. PLOS ONE, 2016, 11(3):e0151853-e0151853.
    [3] Baggott C D , Aagaardkienitz B . Cerebral Vasospasm[J]. NEUROSURG CLIN N AMS, 2014, 25(3):497-528.
    [4] Izzy S , Muehlschlegel S . Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage and Traumatic Brain Injury[J]. CURR TREAT OPTION NES, 2014, 16(1):278-278.
    [5] 中华医学会神经外科学分会. 脑血管痉挛防治神经外科专家共识[J]. 中华医学杂志, 2008, 3(31):356-362.
    [6] 杨位霞, 毛蕾蕾, 袁慧. 蛛网膜下腔出血后迟发性脑血管痉挛的机制[J]. 中华行为医学与脑科学杂志, 2014,23(11):1048-1050.
    [7] 徐斐, 敖虎山. 盐酸右美托咪定的临床应用[J]. 中国循环杂志, 2015,30(4):401-403.
    [8] 中华医学会神经病学分会. 中国蛛网膜下腔出血诊治指南2015[J]. 中华神经科杂志, 2016, 49(3):182-191.
    [9] 孟馥芬, 维拉, 宣斐, 等. 右美托咪定在颅脑肿瘤手术中的应用[J]. 临床麻醉学杂志, 2014, 30(11):1104-1106.
    [10] Papanikolaou J , Spathoulas K , Makris D , ea al. Hemodynamic challenges in traumatic subarachnoid hemorrhage complicated by cerebral vasospasm[J]. AM J EMERG MEDS, 2016, 34(5):904-906.
    [11] Malinova V , Schatlo B , Voit M , 等. Identification of specific age groups with a high risk for developing cerebral vasospasm after aneurysmal subarachnoid hemorrhage[J]. NEUROSURG REVS, 2016, 39(3):429-436.
    [12] 李国兰, 武伟, 贺昌林. 右美托咪定在脑出血术后患者的镇静效果及安全性评价[J]. 中国临床药理学杂志, 2016, 32(1):9-11.
    [13] 章玲宾, 樊理华, 卢向红, 等. 右美托咪定对颅内动脉瘤夹闭术围麻醉期血流动力学的影响[J]. 中国药物与临床, 2013, 13(4):491-492.
    [14] 罗建民, 魏磊, 吴学东, 等. 右美托咪定对经皮冠状动脉介入治疗患者氧化应激的影响[J]. 临床麻醉学杂志, 2017, 33(7):668-670.
    [15] 陈晓梅, 陈广福. 右美托咪定对颅内肿瘤手术患者血流动力学的影响及脑保护作用[J]. 临床麻醉学杂志, 2015, 31(1):15-17.
    [16] 苏玲, 屠伟峰, 陈茜, 等. 右美托咪定对血管内皮细胞氧化应激损伤的影响[J]. 实用医学杂志, 2013, 29(9):1397-1399.
  • 期刊类型引用(4)

    1. 李兴维,姚群. 右美托咪定口服与滴鼻在小儿包皮环切术麻醉中的应用分析. 中国实用医药. 2022(05): 142-145 . 百度学术
    2. 秦美英. 右美托咪定在蛛网膜下腔麻醉下子宫肌瘤切除术中的应用. 中外医疗. 2022(16): 71-74 . 百度学术
    3. 李长宝,宋保新,沈俊岩,张云鹏. 动脉瘤性蛛网膜下腔出血患者血清Cav-1、FoxO3a mRNA表达水平及与预后的关系. 疑难病杂志. 2022(12): 1230-1235+1247 . 百度学术
    4. 孙志强,李蒙蒙,纪淑敏,张爱莲,蔡红苗,王乔,王清秀. 右美托咪定滴鼻用于小儿腹腔镜疝囊高位结扎术的临床观察. 同济大学学报(医学版). 2020(06): 779-783 . 百度学术

    其他类型引用(0)

计量
  • 文章访问数:  2312
  • HTML全文浏览量:  0
  • PDF下载量:  833
  • 被引次数: 4
出版历程
  • 收稿日期:  2019-01-29
  • 修回日期:  2019-05-14
  • 刊出日期:  2019-06-24

目录

    /

    返回文章
    返回