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林赛娟田国刚姚欢琦田毅王颖林董盛龙王召燕朱少飞.右美托咪啶复合芬太尼及七氟烷用于脑肿瘤手术的麻醉效果及对血流动力学的影响[J].现代生物医学进展英文版,2015,15(18):3540-3543.

右美托咪啶复合芬太尼及七氟烷用于脑肿瘤手术的麻醉效果及对血流动力学的影响

Anesthesia Effect of Dexmedetomidine Combined with Fentanyl andSevoflurane in Brain Tumor Operation and Its Influence on Hemodynamics

DOI：

中文关键词: 右美托咪啶丙泊酚芬太尼七氟烷脑肿瘤

英文关键词: Dexmedetomidine Propofol Fentanyl Sevoflurane Brain tumor

基金项目:海南省自然科学基金项目（2012-SZR-04-07 812170）

Author Name	Affiliation
林赛娟田国刚姚欢琦田毅王颖林董盛龙王召燕朱少飞	海口市人民医院/ 中南大学湘雅医学院附属海口医院麻醉科

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中文摘要:

目的：探讨右美托咪啶复合芬太尼及七氟烷用于脑肿瘤手术的麻醉效果及对血流动力学的影响。方法：择期全麻下行脑肿瘤切除术患者40 例，随机分为右美托咪啶组（D 组）和丙泊酚组（P 组）各20 例。麻醉诱导前D 组静脉输注右美托咪啶0.5 滋g/kg，P 组给予同等容量的生理盐水，均15 min 泵注完成。静脉注射咪唑安定、芬太尼、顺式阿曲库铵、依托咪酯行麻醉诱导。术中均用芬太尼、七氟烷、顺式阿曲库铵维持麻醉，D组持续静脉输注右美托咪啶0.2~1.0 滋g·kg-1·h-1，P 组给予丙泊酚3~10 mg·kg-1·h-1，调整右美托咪啶及丙泊酚用量，使BIS值维持于40~50。于麻醉用药前（基础值）（T0）、麻醉诱导气管插管前（T1）、气管插管后（T2）、切开硬脑膜（T3）、取瘤（T4）、术毕（T5）、拔气管导管时（T6）记录心率（HR）、血压（SBP、DBP）。记录手术时间、输液量、出血量、苏醒时间、拔管时间及拔管后10 min 警觉/ 镇静（OAA/S）评分。结果：与T0 比较，D 组T1、T3、T4 时SBP、DBP明显降低（P＜0.05）， HR明显减慢（P＜0.05），但仍接近正常值，P 组T1 时SBP、DBP明显降低（P＜0.05），HR 明显减慢（P＜0.05），T2、T5、T6 时SBP、 DBP明显升高（P＜0.05），HR 明显加快（P＜0.05）。与P 组比较，T2~T6 时D组SBP、DBP明显低于P 组（P＜0.05），HR明显慢于 P组（P＜0.05）。D组苏醒时间、拔管时间明显短于P组（P＜0.05），拔管后10min OAA/S评分显著高于P组（P＜0.05）。结论：右美托咪啶或丙泊酚复合芬太尼、七氟烷麻醉用于脑肿瘤手术均能够提供满意的麻醉效果，右美托咪啶能抑制气管插管、拔管等引起的血流动力学反应，术后苏醒快且苏醒质量高。

英文摘要:

Objective:To investigate the anesthesia effect of dexmedetomidine combined with fentanyl and s oflurane in brain tumor operation and its influence on hemodynamics.Methods:A total of 40 patients, undergoing elective brain tumor resection under general anesthesia, were randomly divided into dexmedetomidine group (D group, n=20) and propofol group (P group, n=20). Before anaesthesia, D group was treated with intravenous dexmedetomidine ( 0.5 滋g/kg) induction, and P group, the equivalent volumes of normal saline for 15 mins. The two grups were treated with intravenous midazolam, fentanyl, CIS atracurium, etomidate for anesthesia induction. Fentanyl, sevoflurane and CIS atracurium were used to maintain the anesthesia of the two groups during the operation; then D group was given with continuous intravenous infusion of dexmedetomidine 0.2~1.0 滋g·kg-1·h-1; while P group, propofol 3~10 mg·kg-1· h-1. After that, the dosage of dexmedetomidine and propofol were adjusted to keep the BIS value in 40~50. HR, SBP, DBP were recorded before anaesthesia (T0), before tracheal intubation of anesthesia induction (T1), after tracheal intubation (T2), dura mater incision(T3), taking tumor (T4), operation completing (T5), and tracheal extubation (T6); record the operation time, transfusion volume, amount of bleeding,awakening time, extubation time and the OAA/S score 10 min after extubation.Results:Compared with T0, the SBP, DBP were obviously cut down(P＜0.05) and HR was slower of D group at T1, T3, T4(P＜0.05), but they were still close to the normal value;while the SBP, DBP were obviously cut down(P＜0.05) and HR was slower of P group at T1(P＜0.05), and SBP, DBP obviously increased(P＜ 0.05) and HR was faster at T2, T5, T6(P＜0.05). SBP and DBP ofD group were significantly lower than those of P group at T2~T6 (P＜ 0.05), and the HR was slower than P group (P＜0.05). The awakening and extubation time of D group were significantly shorter than those of P group (P＜0.05), and the OAA/S score 10 mins after extubation of D group was higher than that of P group (P＜0.05).Conclusion:Dexmedetomidine or propofol combined with fentanyl and sevoflurane has an excellent anesthesia effect in brain tumor operation, and dexmedetomidine can restrain the hemodynamic response caused by the tracheal intubation and extubation, with a faster and high quality of postoperative awakening.

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