2025 年第 3 期 第 20 卷

右美托咪定联合瑞芬太尼在脑卒中患者介入取栓术中的应用效果及对脑代谢和抗氧化的影响

Application effect of dexmedetomidine combined with remifentanil in patients with stroke undergoing interventional thrombectomy and its influence on cerebral metabolism and antioxidation

作者：张宁1程燕2刘永堂3韩伟4季辉4黄永军5

英文作者：Zhang Ning1 Cheng Yan2 Liu Yongtang3 Han Wei4 Ji Hui4 Huang Yongjun5

单位：1河北工程大学附属医院麻醉科，邯郸056200；2华北医疗健康集团峰峰总医院输血科，邯郸056200；3华北医疗健康集团峰峰总医院普外科，邯郸056200；4华北医疗健康集团峰峰总医院麻醉科，邯郸056200；5山东省滨州市沾化区人民医院神经内科，滨州256600

英文单位：1Department of Anesthesiology Affiliated Hospital of Hebei University of Engineering Handan 056200 China; 2Department of Blood Transfusion Fengfeng General Hospital of North China Medical and Health Group Handan 056200 China; 3Department of General Surgery Fengfeng General Hospital of North China Medical and Health Group Handan 056200 China; 4Department of Anesthesiology Fengfeng General Hospital of North China Medical and Health Group Handan 056200 China; 5Department of Neurology People′s Hospital of Zhanhua District Binzhou City Shandong Province Binzhou 256600 China

关键词：脑卒中；右美托咪定；瑞芬太尼；介入取栓术

英文关键词：Stroke;Dexmedetomidine;Remifentanil;Interventionalthrombectomy

• 摘要：

• 目的 探讨右美托咪定联合瑞芬太尼在脑卒中患者介入取栓术中的应用效果及对脑代谢、抗氧化的影响。方法 选取2022年1月至2023年12月河北工程大学附属医院收治的缺血性脑卒中患者96例，采用随机数字表法分为对照组和观察组，各48例。所有患者接受介入取栓术治疗，对照组予以瑞芬太尼麻醉，观察组在对照组基础上予以右美托咪定麻醉。比较2组麻醉即刻、麻醉后1 h脑代谢指标，术前、术后1 h血清指标、颅内压，以及术后睁眼时间、Ramsay评分和不良反应发生情况。结果 观察组麻醉后1 h动脉-颈内静脉球部血氧差、颈内静脉血氧含量、脑代谢率、颈内静脉球血氧饱和度均高于对照组（均P<0.05）。2组术后1 h血清丙二醛、内皮素、超氧化物歧化酶水平均高于术前，但观察组均低于对照组（均P<0.05）。术后1 d，2组颅内压水平均低于术前，且观察组低于对照组［（167±20）mmH2O（1 mmH2O=0.009 8 kPa）比（182±22）mmH2O］（t=3.524，P=0.001）。观察组术后睁眼时间短于对照组［（9.3±1.2）min比（12.2±2.8）min］（t=6.570，P=0.001），Ramsay评分高于对照组［（4.3±0.5）分比（4.0±0.6）分］（t=3.127，P=0.002）。结论 在脑卒中介入取栓术中采取右美托咪定与瑞芬太尼联合麻醉方案，能提高脑代谢及抗氧化能力，减轻氧化应激和炎症反应，降低颅内压，促进术后恢复，且具有一定的安全性。

• Objective  To investigate the application effect of dexmedetomidine combined with remifentanil in patients with stroke undergoing interventional thrombectomy and its influence on cerebral metabolism and antioxidation. Methods A total of 96 patients with ischemic stroke admitted to Affiliated Hospital of Hebei University of Engineering from January 2022 to December 2023 were selected. According to the random number table method, they were divided into the control group and the observation group, with 48 cases in each group. All patients received interventional thrombectomy. The control group was given remifentanil anesthesia, and the observation group was given dexmedetomidine anesthesia on the basis of the control group. The cerebral metabolic indexes immediately after anesthesia and 1 h after anesthesia, serum indexes and intracranial pressure before and 1 h after operation, postoperative eye opening time, Ramsay score, and adverse reactions were compared between the two groups. Results The blood oxygen difference of internal jugular vein bulb, blood oxygen content of internal jugular vein, cerebral metabolic rate and oxygen saturation of internal jugular vein bulb in the observation group were higher than those in the control group at 1 hour after anesthesia (all P<0.05). The serum levels of malondialdehyde, endothelin and superoxide dismutase 1 hour after operation in the two groups were higher than those before operation, but those in the observation group were lower than those in the control group (all P<0.05). One day after operation, the intracranial pressure levels of the two groups were lower than those before operation, and that of the observation group was lower than that of the control group ［(167±20)mmH2O vs (182±22)mmH2O］(t=3.524, P=0.001). The postoperative eye opening time of the observation group was shorter than that of the control group ［(9.3±1.2)min vs (12.2±2.8)min］(t=6.570, P=0.001), and the Ramsay score was higher than that of the control group ［(4.3±0.5) vs (4.0±0.6)］(t=3.127, P=0.002). Conclusions  Dexmedetomidine combined with remifentanil anesthesia in interventional thrombectomy for stroke can improve brain metabolism and antioxidant capacity, reduce oxidative stress and inflammatory reaction, reduce intracranial pressure, promote postoperative recovery, and has certain safety.