脑肿瘤术中应用右旋美托咪啶对芬太尼剂量及血流动力学的影响

Effect of Dexmedetomidine on the Intraoperative Fentanyl Requirements and Perioperative Hemodynamics in Patients Undergoing Intracranial Tumor Surgery

关键词:  脑肿瘤术  右旋美托咪啶  芬太尼  血流动力学

Key words:  intracranial tumor surgery  dexmedetomidine  fentanyl  perioperative hemodynamics

摘要:

目的 观察脑肿瘤术中应用右旋美托咪啶对芬太尼剂量及血流动力学的影响。方法 选择30例ASAⅠ-Ⅱ级欲行脑肿瘤切除术患者，随机分成右旋美托咪啶组和安慰剂组，右旋美托咪啶组给予负荷剂量0.5 μg·kg^-1(20 min)的右旋美托咪啶，然后0.9 μg·kg^-1·h^-1泵注，安慰剂组则给予同一容量和外形相似的生理盐水。观察术中麻醉药的用量和血流动力学变化。结果 右旋美托咪啶组术中芬太尼用量、麻醉诱导后40 min内及术终的心率、平均压与安慰剂组相比显著降低；麻醉诱导60 min后的七氟烷呼末浓度右旋美托咪啶组与安慰剂组相比明显降低。结论 脑肿瘤术中应用右旋美托咪啶可降低术中心率和平均压，并减少麻醉药用量。

Abstract:

OBJECTIVE To assess the effect of dexmedetomidine on the intraoperative fentanyl requirements and perioperative hemodynamics in patients undergoing intracranial tumor surgery. METHODS Thirty patients scheduled for intracranial tumor surgery were recruited, randomized assigned into receive dexmedetomidine or placebo groups, D and P, respectively. In group D patients received a loading dose of dexmedetomidine 0.5 μg·kg^-1 over 20 minutes, followed by a continuous infusion of a rate of 0.9 μg·kg^-1·h^-1. In group P, patients received a volume matched 0.9% saline. Opioid requirement, heart rate (HR), blood pressure (BP) and end-tidal sevoflurane concentration were monitored. RESULTS The fentanyl consumption was 436.7, 663.3 μg in the D and P groups, respectivly (P<0.05 for comparison of the D and P group). From the anesthesia induction to 40 min after anesthesia induction, the D group had slower heart rate and lower mean arterial blood pressure .The end-tidal sevoflurane concentration was lower in the D group after 60 min of anesthesia induction. CONCLUSION Intraoperative dexmedetomidine infusion significantly decreases fentanyl and sevoflurane consumption, increases intraoperative haemodynamic stability during intracranial tumor surgery.