Article Summary
右美托咪定对脑肿瘤切除术患者麻醉镇静效果的前瞻性单中心随机对照研究
Prospective single center randomized controlled study on the anesthetic and sedative effects of dexmedetomidine in patients undergoing brain tumor resection surgery
投稿时间:2025-04-28  修订日期:2025-04-28
DOI:
中文关键词: 右美托咪定  脑肿瘤  镇静  血流动力学  应激反应
英文关键词: Dexmedetomidine  Brain tumors  Sedative  Hemodynamic  Stress response
基金项目:吉林省科技厅自然科学基金(20160101120JC)
作者单位邮编
陈艳艳* 山东大学齐鲁医院 250012
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中文摘要:
      目的:观察右美托咪定在脑肿瘤切除术中的应用效果。方法:选取2023年9月-2024年9月期间于我院行脑肿瘤切除术的60例患者,采用随机数字表法将患者分为参照组(常规麻醉,n=30)和试验组(参照组的基础上结合右美托咪定,n=30)。对比两组神经元特异性烯醇化酶(NSE )、血糖、血流动力学指标[平均动脉压(MAP)及心率(HR)],观察两组苏醒时间、术中阿片类药物使用情况、镇静程度、拔管时间及不良反应发生情况。结果:与插管时(T1)时间点对比,参照组手术开始时(T2)~钻颅骨时(T3)时间点的MAP依次降低(P<0.05);与手术结束时(T5)时间点的MAP对比,参照组回重症监护室后(T6)时间点的MAP升高(P<0.05)。试验组麻醉诱导前(T0)~T2时间点的MAP依次降低(P<0.05);与T5时间点对比,试验组T6时间点的MAP升高(P<0.05)。试验组T1~T3时间点、T6时间点的MAP低于参照组(P<0.05)。参照组T0~T2时间点的HR先升高后下降(P<0.05);与T5时间点的HR对比,参照组T6时间点的HR升高(P<0.05)。与T1时间点对比,试验组T2~T3时间点的HR先下降后升高(P<0.05);与T5时间点的HR对比,试验组T6时间点的HR升高(P<0.05)。试验组T1~切除肿瘤后(T4)时间点、T6时间点的HR低于参照组(P<0.05)。两组T5时间点的NSE升高,但试验组低于对照组(P<0.05)。与同组T0时间点的血糖对比,参照组T5时间点的血糖升高,试验组T5时间点的血糖降低,且试验组T5时间点的血糖低于参照组(P<0.05)。两组苏醒时间、拔管时间、术后Ramsay评分组间对比无差异(P>0.05),但试验组瑞芬太尼的用量低于参照组(P<0.05)。试验组的不良反应总发生率低于参照组(P<0.05)。结论:右美托咪定应用于脑肿瘤切除术患者,可稳定患者血流动力学,抑制应激反应,且可显著降低瑞芬太尼的用量和不良反应的发生风险,具有良好的镇静效果和安全性。
英文摘要:
      Objective: To observe the application effect of dexmedetomidine in brain tumor resection surgery. Method: 60 patients who underwent brain tumor resection surgery in our hospital from January 2023 to December 2024 were selected, the patients were randomly divided into reference group (conventional anesthesia, n=30) and experimental group (reference group combined with dexmedetomidine, n=30) used random number table method.Neuron specific enolase (NSE), blood glucose, hemodynamic indicators [mean arterial pressure (MAP) and heart rate (HR)] between the two groups were compared, the recovery time, intraoperative opioid use, sedative level, extubation time, and occurrence of adverse reactions between the two groups were observed. Result: Compared with the time point of intubation (T1), MAP in the reference group decreased sequentially from the time point of beginning of surgery (T2) to the time point of skull drilling (T3) (P<0.05). Compared with the end of surgery (T5), the MAP at time point of after returning to the intensive care unit (T6) in the reference group increased (P<0.05). MAP in the experimental group decreased sequentially from the time point of before anesthesia induction (T0) to T2 (P<0.05). Compared with the time point of T5, MAP in the experimental group at time point of T6 increased (P<0.05). MAP in the experimental group at time points of T1-T3 and T6 was lower than that in the reference group (P<0.05). HR in the reference group at time points of T0~T2 first increased and then decreased (P<0.05), Compared with HR at time point of T5, HR at time point of T6 in the reference group increased (P<0.05). Compared with the time point of T1, HR in the experimental group decreased first and then increased from the time point of T2 to T3 (P<0.05). Compared with HR at time point of T5, HR at time point of T6 in the experimental group increased (P<0.05). HR in the experimental group at time points of T1 to after tumor resection (T4) and T6 were lower than those in the reference group (P<0.05). NSE levels increased in both groups at time points of T5, but the experimental group was lower than that in the control group (P<0.05). Compared with the blood glucose at time point of T0 in the same group, the blood glucose at time point of T5 in the reference group increased, while the blood glucose at time point of T5 in the experimental group decreased, and the blood glucose at time point of T5 in the experimental group was lower than that in the reference group (P<0.05). There was no significant difference in the recovery time, extubation time,and postoperative Ramsay score between the two groups (P>0.05),but the dosage of remifentanil in the experimental group was lower than that in the reference group (P<0.05).The overall incidence of adverse reactions in the experimental group was lower than that in the reference group (P<0.05). Conclusion:The application of dexmedetomidine in patients undergoing brain tumor resection surgery can stabilize the hemodynamics of patients, inhibit the stress response, and significantly reduce the dosage of remifentanil and the risk of adverse reactions. It has good sedative effect and safety.
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