右美托咪定对脑功能区手术术中唤醒质量的影响

Effects of Dexmedetomidine on the Quality of Intraoperative Wake-up Test During Cerebral Functional Area Operation

关键词:  右美托咪啶  丙泊酚  唤醒试验

Key words:  dexmedetomidine  propofol  wake-up test

摘要:

目的 评价右美托咪定对丙泊酚和舒芬太尼麻醉下脑功能区手术术中唤醒质量的影响。方法 拟行术中唤醒试验的脑功能区手术患者40例，年龄18~65岁，ASA分级Ⅰ或Ⅱ级，采用完全随机法将患者随机分为2组：对照组和右美托咪定组，每组20例。右美托咪定组麻醉诱导前10 min静脉输注右美托咪定1 μg?kg^-1，对照组则静脉输注等量生理盐水，此后2组均靶控输注丙泊酚和舒芬太尼诱导与维持。丙泊酚血浆靶浓度为3~5 μg?mL^-1，维持脑电双频指数(BIS)45~55；舒芬太尼效应室靶浓度0.1~0.2 ng?mL^-1。麻醉维持期，右美托咪定组右美托咪定速率下调到0.4 μg?kg^-1?h^-1，对照组则静脉输注等量生理盐水。硬脑膜打开后，2组均停止输注丙泊酚及肌松药，并将舒芬太尼效应室靶浓度调整为0.1 ng?mL^-1；此时右美托咪定组右美托咪定速率下调到0.1 μg?kg^-1?h^-1，而对照组给予输注等量生理盐水。同时，记录唤醒前麻醉时间、唤醒前麻醉药用量、唤醒时间、唤醒期间并发症以及术中知晓等的发生情况。结果 所有患者均成功实施唤醒，并顺利完成手术。与对照组比较，右美托咪定组唤醒前丙泊酚用量减少，唤醒试验期间高血压、心动过速、头痛和术中知晓的发生率均降低，唤醒时间缩短，差异均具有有统计学意义(P<0.05)。BIS值差异无统计学意义(P>0.05)。结论 右美托咪定可以缩短脑功能区手术患者的唤醒时间，提高唤醒试验质量。

Abstract:

OBJECTIVE To evaluate the effect of dexmedetomidine on patients receiving cerebral functional area operation during wake-up test performed under propofol combined with sufentani anesthesial. METHODS Forty ASA physical status Ⅰ or Ⅱ patients,undergoing cerebral functional area operation, requring wake-up test, aged 18?65 years old, weighing 50?70 kg, were randomly divided into control group and dexmedetomidine group with 20 cases in each one. Dexmedetomidine (1 μg?kg^-1) was infused over 10 min before anesthesia induction in dexmedetomidine group; meanwhile, control gorup received an equal volume of normal saline. Anesthesia was induced with target-controlled(TCI) infusion of propofol and sufentanil and cisatracurium. After endotracheal intubation, dexmedetomidine was infused at 0.4 μg?kg^-1?h^-1. TCI of propofol and sufentanil was used to maintain the anesthesia condition as followed: concentration of propofol in plasma was 3-5 μg?mL^-1 with BIS value from 45 to 55; effect-site target concentration of sufentanil was adjusted at 0.1-0.2 ng?mL^-1. Patients in both groups received scalp nerve block, local infiltration into incision and dura mater during the operation. After the dura was open, propofol was withdrawed and the concentration of sufentanil was decreased to 0.1 ng?mL^-1, and in dexmedetomidine group the infusion rate of dexmedetomidine was decrease to 0.1 μg?kg^-1?h^-1. Anesthesia time and consumption of anesthetics before wake-up test, wake-up time, and development of complications and intraoperative awareness during wake-up test were recorded. RESULTS All patients successfully awaked, patiens in dexmedetomidine group need less consumption of propofol than those in control group(P<0.05); the incidence of hypertension, tachycardia, headache and awareness were significantly decreased in dexmedetomidine group than those in control group(P<0.05); the time to arouse the patients during operation was also significantly shorter in dexmedetomidine group than control group(P<0.05). No significant difference in BIS value was found in dexmedetomidine group. CONCLUSION Dexmedetomidine can reduce wake-up time and raise the quality of wake-up test in patients undergoing cerebral functional area operation under propofol combined with sufentanil anesthesia.