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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.

     

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