2019 年第 12 期 第 14 卷

右美托咪定复合麻醉对脑功能区手术患者术中唤醒质量及应激反应的影响

Effect of combined anesthesia with dexmedetomidine on intraoperative arousal quality and stress response in patients undergoing cerebral functional area surgery

作者：薛永耐胡小丽

英文作者：

单位：400061中国人民武装警察部队重庆市总队医院麻醉科

英文单位：

关键词：脑功能区手术；右美托咪定；术中唤醒；应激反应

英文关键词：

• 摘要：

• 【摘要】目的    探讨右美托咪定复合麻醉对脑功能区手术患者术中唤醒质量分级和应激反应指标水平的影响。方法    选取中国人民武装警察部队重庆市总队医院2016年9月至2018年9月行脑功能区手术患者98例，按照随机数字表法分为观察组和对照组，各49例。麻醉诱导前10 min观察组患者静脉注射0.8 μg/kg右美托咪定，对照组注射等量0.9%氯化钠注射液；对照组术中采用丙泊酚、瑞芬太尼、顺苯磺阿曲库铵进行维持麻醉，观察组在对照组基础上使用右美托咪定进行复合麻醉，比较2组患者麻醉诱导后、麻醉唤醒前30 min、唤醒即刻、加深麻醉后10 min的平均动脉压和心率变化，从停用丙泊酚至患者清醒的时间（唤醒时间）、麻醉药物使用总量、唤醒质量分级、警觉/镇静评分、血浆去甲肾上腺素（NE）和肾上腺素水平以及不良反应发生率。结果    麻醉唤醒前30 min、唤醒即刻2组患者平均动脉压和心率均高于麻醉诱导后，但观察组麻醉唤醒前30 min、唤醒即刻平均动脉压和唤醒即刻心率低于对照组,差异均有统计学意义（均P<0.05）。观察组患者术中唤醒时间短于对照组［(15±6)min比（19±7）min］，警觉/镇静评分低于对照组［(2.3±0.6)分比（3.7±0.5）分］，唤醒质量分级Ⅰ、Ⅱ级比例高于对照组，Ⅲ、Ⅳ级比例低于对照组，丙泊酚和瑞芬太尼使用量低于对照组,差异均有统计学意义（均P<0.05）。观察组唤醒后5 min和手术结束时血浆NE和肾上腺素水平以及手术期间心动过速、躁动、血压升高、呛咳等不良反应发生率均低于对照组，差异均有统计学意义（均P<0.05）。结论    采用右美托咪定复合丙泊酚和瑞芬太尼麻醉能够显著提高脑功能区手术患者术中唤醒质量，有助于稳定唤醒期间血流动力学，降低患者术中应激反应和不良反应。

• 【Abstract】Objective    To investigate the effect of combined anesthesia with dexmedetomidine on quality grading of intraoperative arousal and stress response indexes in patients undergoing cerebral functional area surgery. Methods    A total of 98 patients undergoing cerebral functional area surgery were selected from Armed Police Force Hospital of Chongqing between September 2016 and September 2018. They were randomly divided into observation group and control group, with 49 cases in each group. The observation group was intravenously injected with 0.8 μg/kg dexmedetomidine and the control group had 0.9% sodium chloride injection at 10 min before anesthesia induction. The control group had continuous anesthesia with propofol, remifentanil and cis benzene. The observation had combined anesthesia with dexmedetomidine on the basis of the maintenance regimen in control group. Mean arterial pressure and heart rate were observed during operation. Wake-up time（cessation of propofol to waking）, total dosage of anesthetics, grading of arousal quality, alertness/sedation score, plasma norepinephrine(NE) and adrenaline levels, and incidence of adverse events were analyzed. Results    Mean arterial pressure and heart rate significantly increased at 30 min before waking and after waking compared to those after anesthesia induction in both groups; mean arterial pressure 30 min before waking and after waking and heart rate after waking in observation were significantly lower than those in control group（all P<0.05）. Intraoperative wake-up time in observation group was significantly shorter than that in control group［(15±6)min vs (19±7)min］ and alert/sedation score was significantly lower than that in control group［(2.3±0.6) vs (3.7±0.5)］; the observation group had higher proportions of arousal quality grade Ⅰ and Ⅱ, lower proportions of grade Ⅲ and Ⅳ, and more consumptions of propofol and remifentanil(all P<0.05). Plasma levels of NE and adrenaline 5 min after waking and after operation, incidences of intraoperative adverse events such as tachycardia, agitation, elevation of blood pressure and cough in observation group were significantly lower than those in control group(all P<0.05). Conclusion    Combined anesthesia with dexmedetomidine, propofol and remifentanil can significantly improve the quality of intraoperative arousal in patients undergoing cerebral functional area surgery, help to stabilize hemodynamics during arousal, reduce intraoperative stress response and adverse reactions.