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1. 张家口市第一医院
2. 三河市燕郊人民医院
3. 中国人民解放军第二五一医院
纸质出版日期:2016,
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[1]李智奇,刘东辉,王锡丽,徐志富,刘福增.右美托咪定对动脉瘤性蛛网膜下腔出血围介入栓塞手术期血流动力学的影响[J].保健医学研究与实践,2016,13(01):56-58+63.
Li Zhiqi, Liu Donghui, Wang Xili, et al. The Effect of Dexmedetomidine on Hemodynamics in the Perioperative Period of Interventional Embolization of Aneurysmal Subarachnoid Hemorrhage[J]. Health Medicine Research and Practice, 2016,13(1):56-58.
[1]李智奇,刘东辉,王锡丽,徐志富,刘福增.右美托咪定对动脉瘤性蛛网膜下腔出血围介入栓塞手术期血流动力学的影响[J].保健医学研究与实践,2016,13(01):56-58+63. DOI:
Li Zhiqi, Liu Donghui, Wang Xili, et al. The Effect of Dexmedetomidine on Hemodynamics in the Perioperative Period of Interventional Embolization of Aneurysmal Subarachnoid Hemorrhage[J]. Health Medicine Research and Practice, 2016,13(1):56-58. DOI:
目的观察右美托咪定对动脉瘤性蛛网膜下腔出血围介入栓塞手术期血流动力学以及继发脑血管痉挛发生的影响。方法选择2012年10月-2015年2月行介入栓塞手术治疗的动脉瘤性蛛网膜下腔出血患者90例
随机分为右美托咪定组与对照组
每组45例。2组患者均给予相同的麻醉诱导
给予芬太尼2
4
μg/kg静脉泵入镇痛。对照组患者间断给予丙泊酚0.4
0
.6mg/kg进行麻醉维持。右美托咪定组在麻醉诱导期15min内给予右美托咪定0.5
0
.8μg/kg
麻醉维持期给予右美托咪定0.2
0
.5μg/kg·h-1
拔管前10min调整右美托咪定剂量为0.1
0
.2μg/kg。观察2组患者术前(T0)、气管插管后(T1)、脑动脉造影前(T2)、脑动脉造影后10min(T3)、拔管前5min(T4)
拔管后15min(T5)各时间点平均动脉压(MAP)、心率(HR)变化情况。比较2组患者术中脑血管造影显示的血管痉挛发生情况
手术前后大脑中动脉血流速度
术后发生症状性脑血管痉挛情况。结果围手术期
右美托咪定组患者MAP和HR平稳
无大幅升降变化;对照组患者MAP和HR波动幅度较大。2组患者在T0时间点MAP和HR比较
差异无统计学意义;但2组患者在T1
T2
T3
T4时间点的MAP和HR比较
差异均有统计学意义(P
<
0.05)。右美托咪定组患者术中脑血管造影显示血管痉挛的比例为20.00%
低于对照组(37.7%)
差异有统计学意义(P
<
0.01);右美托咪定组患者术后发生症状性脑血管痉挛的比例为11.11%
低于对照组(26.67%)
差异有统计学意义(P
<
0.01)。手术后
右美托咪定组患者大脑中动脉血流速度明显低于对照组
2组比较差异有统计学意义(P
<
0.01)。结论动脉瘤性蛛网膜下腔出血围介入栓塞手术期
应用右美托咪定治疗有助于维持患者血流动力学稳定
防止继发性脑血管痉挛发生。
Objective To investigate the effects of dexmedetomidine on hemodynamics in the perioperative period of interventional embolization of aneurysmal subarachnoid hemorrhage and the occurrence of secondary cerebral vasospasm.Methods 90 cases of patients with aneurysmal subarachnoid hemorrhage who had interventional embolization surgery from October 2012 to February 2015 were randomly divided into dexmedetomidine group and a control group
45 cases in each group.Patients in both groups were given the same anesthesia induction and intravenous infusion analgesia of 2
4
μg/kg of fentanyl.Patients of the control group were intermittently given 0.4
0
.6mg/kg of propofol to maintain anesthesia.Patients of dexmedetomidine group were given 0.5
0
.8μg/kg of dexmedetomidine within 15 minutes of anesthesia induction
0.2
0
.5μg/kg·h-1 of dexmedetomidine in anesthesia maintenance and 0.1
0
.2μg/kg of dexmedetomidine 10 minutes before extubation.Two groups were observed changes of mean arterial pressure(MAP)and heart rate(HR)at different time points:before operation(T0)
tracheal intubation time(T1)
before arteriocerebral angiography(T2)
10 minutes after arteriocerebral angiography(T3)
5minutes before extubation(T4)
15 minutes after extubation(T5)and they were compared their vasospasm of cerebral angiography in operation
artery blood flow velocity before and after operation and postoperative symptomatic cerebral vasospasm.Results During perioperative period
MAP and HR in patients of dexmedetomidine group had no significant change but MAP and HR in patients of the control group had significant changes.There were no significant differences of MAP and HR at T0 time point between the two groups
but the differences of MAP and HR at T1
T2
T3
and T4 time points were statistically significant(P
<
0.05).Cerebral angiography showed 20.00% of patients in dexmedetomidine group had vasospasm in operation
lower than the control group(37.7%)and the difference was statistically significant(P
<
0.01).The incidence of postoperative symptomatic cerebral vasospasm in dexmedetomidine group was 11.11%
lower than the control group(26.67%)and the difference between the two groups was statistically significant(P
<
0.01).After the surgery
cerebral artery blood flow velocity of dexmedetomidine group was significantly lower than the control group and the difference was statistically significant(P
<
0.01).Conclusion The application of dexmedetomidine in the perioperative period of interventional embolization of aneurysmal subarachnoid hemorrhage can help patients maintain hemodynamic stability and prevent the occurrence of secondary cerebral vasospasm.
蛛网膜下腔出血右美托咪定脑血管痉挛
Subarachnoid hemorrhageDexmedetomidineCerebral vasospasm
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