盐酸右美托咪定对颅内动脉瘤介入手术患者血流动力学及术后并发症的影响

摘要
图/表
参考文献(26)
相关文章 (15)

全文: PDF (522 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨颅内动脉瘤介入治疗过程中使用盐酸右美托咪定对患者血流动力学的影响及其颅内压（ICP）改变引起术后神经系统不良反应发生率的情况。方法选取2017年1月~2018年12月河北医科大学第一医院神经科确诊且择期行介入治疗的颅内动脉瘤患者96例为研究对象，依据选用的药物与使用剂量的不同将其分为盐水组（A组）、低剂量盐酸右美托咪定组（B1组）、高剂量盐酸右美托咪定组（B2组），每组32例。B1、B2组在手术结束前30 min开始泵入0.6、1.2 μg/kg的盐酸右美托咪定，持续时间为20 min，A组泵入生理盐水。记录并比较三组患者术前（T0）、给药时刻（T1）、手术结束时刻（T2）、苏醒时刻（T3）、拔管时刻（T4）及拔管后（T5）ICP、平均动脉压（MAP）、心率（HR）及术后恢复相关指标（苏醒所需时间、术后拔管时间与Ramsay镇静评分），比较术后神经系统不良反应发生情况。结果 B1组T2~T4时点ICP低于A组，T2~T5时点MAP、HR低于A组，差异均有统计学意义（均P < 0.05），B2组T2~T4时点ICP低于A、B1组，T2~T5时点MAP低于A、B1组，T1~T5时点HR低于A、B1组，差异均有统计学意义（均P < 0.05）。与A组比较，B1组苏醒所需时间、术后拔管时间差异无统计学意义（P ＞ 0.05）；B1组Ramsay镇静评分高于A组，差异有统计学意义（P ＜ 0.05）。B2组苏醒所需时间、术后拔管时间长于A、B1组；Ramsay镇静评分高于A、B1组，差异有统计学意义（P ＜ 0.05）。三组术后神经系统不良反应发生率比较，差异有统计学意义（P ＜ 0.05）。B1、B2组神经系统不良反应发生率明显低于A组，差异均有统计学意义（均P < 0.05）；B1组与B2组神经系统不良反应发生率比较，差异无统计学意义（P > 0.05）。结论手术结束前给予小剂量盐酸右美托咪定可以有效稳定患者血流动力学，改善脑组织灌注，降低ICP，减少术后神经系统不良反应发生。早期干预应用盐酸右美托咪定对颅内动脉瘤介入手术患者有一定的获益性应用价值。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	史记1 张娜娜2 赵帅3 李伟靖4 刘雅5 周长浩1▲

关键词 ：颅内动脉瘤, 保护, 血流动力学, 镇静, 右美托咪定

Abstract：Objective To investigate the effect of Dexmedetomidine Hydrochloride on hemodynamics and postoperative neurological adverse reactions caused by intracranial pressure (ICP) change during interventional therapy of intracranial aneurysm. Methods From January 2017 to December 2018, 96 cases diagnosed as intracranial aneurysm and receiving elective interventional treatment in the First Hospital of Hebei Medical University were selected as subjects. They were divided into saline group (group A), low-dose Dexmedetomidine Hydrochloride group (group B1), and high-dose Dexmedetomidine Hydrochloride group (group B2) according to the drugs selected and the dose used, with 32 cases in each group. At the time of 30 minutes before ending surgery , Dexmedetomidine Hydrochloride was injected into B1 and B2 groups at 0.6 μg/kg and 1.2 μg/kg and continued for about 20 minutes, while group A was pumped in saline. ICP, mean arterial pressure (MAP) and heart rate (HR) of the three groups were recorded at the time of the preoperative (T0), administration (T1), ending surgery (T2), recovery (T3), extubation (T4) and post-extubation (T5). Postoperative recovery indicators (recovery time, postoperative extubation time and Ramsay sedation score) and incidence of neurological adverse reactions of three groups were compared. Results ICP of group B1 was lower than that of group A at T2-T4, MAP and HR of group B1 were lower than those of group A at T2-T5, and the differences were statistically significant (all P < 0.05). At T2-T4, ICP of group B2 were lower than those of group A and B1, MAP of group B2 were lower than those of group A and B1 at T2-T5, HR of group B2 was lower than that of group A and B1 at T1-T5, and the differences were statistically significant (all P < 0.05). Compared with group A, group B1 showed no statistically significant difference in the recovery time and postoperative extubation time (P > 0.05). Ramsay sedation score in group B1 was higher than that in group A, with statistically significant difference (P < 0.05). The recovery time and postoperative extubation time of group B2 were longer than those of group A and group B1, Ramsay sedation score of group B2 was higher than that of group A and group B1, and the differences were statistically significant (P < 0.05). The incidence of postoperative adverse reactions in the nervous system of three groups were significantly differences (P < 0.05). The incidence of adverse nervous system reactions in group B1 and B2 were significantly lower than those in group A, with statistically significant differences (all P < 0.05). There was no significant difference in the incidence of neurological adverse reactions between group B1 and group B2 (P > 0.05). Conclusion Small doses of Dexmedetomidine Hydrochloride before ending surgery can effectively stabilize the hemodynamics of patients, improve cerebral perfusion, reduce intracranial pressure and the incidence of postoperative neurological adverse reactions. Early intervention with Dexmedetomidine Hydrochloride produces beneficial application value in patients with intracranial aneurysm undergoing interventional surgery.

Key words： Intracranial aneurysm Protection Hemodynamics Sedation Dexmedetomidine

基金资助:河北省医学科学研究重点课题（20160693）。

通讯作者: ▲通讯作者

引用本文:

史记1 张娜娜2 赵帅3 李伟靖4 刘雅5 周长浩1▲. 盐酸右美托咪定对颅内动脉瘤介入手术患者血流动力学及术后并发症的影响[J]. 中国医药导报, 2020, 17(7): 115-119.
SHI Ji1 ZHANG Na′na2 ZHAO Shuai3 LI Weijing4 LIU Ya5 ZHOU Changhao1▲. Effect of Dexmedetomidine Hydrochloride on hemodynamics and postoperative complications in patients with intracranial aneurysm undergoing interventional surgery. 中国医药导报, 2020, 17(7): 115-119.

链接本文:

http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2020/V17/I7/115

[1] 郑津，胡学斌，赵洪洋，等.血管介入栓塞治疗时机对颅内动脉瘤患者并发症及神经功能的影响[J].中国医药，2018，13（2）：219-223.
[2] Liu H，Park D，Hwang SM，et al. Outpatient Day-care Neuroangiography and Neurointervention of Unruptured Intracranial Aneurysms [J]. Neurointervention，2016，11（1）：37-41.
[3] Miller JD，Butter worth JF，Gudeman SK，et al. Further experience in the management of severe head in jury [J]. J Neurosurg，1981，54（3）：289-299.
[4] Marshall LF，Smith RW，Shapiro HM. The outcome with aggressive treatment in severe head injuries [J]. J Neurosurg，1979，50（1）：20-25.
[5] 焦莉，孔静，张红莉，等.盐酸右美托咪定和咪达唑仑在ICU患者机械通气中的镇静效果分析[J].保健医学研究与实践，2018，15（6）：47-50.
[6] 史记，刘雅，周长浩，等.盐酸右美托咪定对颅内动脉瘤介入手术患者术中及苏醒期血流动力学的影响[J].河北医药，2017，39（24）：3719-3722.
[7] 曾敏，邢燕，金旭，等.右美托咪啶在颅内动脉瘤血管内栓塞术中的应用价值[J].中国医药导报，2013，10（33）：107-110.
[8] 李星海，赵卫，杨净松，等.脑动静脉畸形伴发动脉瘤的出血风险因素分析及介入治疗[J].中国介入影像与治疗学，2018，15（4）：204-208.
[9] 宋志强，朱安林，陈锐锋，等.颅内动脉瘤急症介入术后神经系统并发症相关因素探讨[J].介入放射学杂志，2019， 28（5）：411-414.
[10] 钟周军，胡秋根，杨少民，等.双源CT大螺距前瞻扫描在胸痛三联症成像中的应用价值[J].中国中西医结合影像学杂志，2017，15（3）：313-315.
[11] 李力，张小曦，赵瑞，等.颅内未破裂动脉瘤介入治疗程序相关性术中破裂的危险因素及临床特点分析[J].第二军医大学学报，2017，38（12）：1491-1496.
[12] Carney N，Totten AM，O′Reilly C，et al. Guidelines for the Management of Severe Traumatic Brain Injury，Fourth Edition [J]. Neurosurgery，2017，80（1）：6-15.
[13] Godoy DA，Suarez PDG，Moscote-Salazar LR，et al. Side effects of indomethacin in refractory post-traumatic intracranial hypertension：a comprehensive case study and review [J]. Bull Emerg Trauma，2017，5（3）：143-451.
[14] 王幸伟，韩玉慧.血管内介入栓塞术对颅内动脉瘤患者术后恢复影响[J].实用中西医结合临床，2018，18（5）：48-50.
[15] 李亚捷，王磊，谷震，等.3D路径图用于颅内动脉瘤介入治疗对手术时间和X射线辐射剂量的影响研究[J].临床和实验医学杂志，2018，17（10）：1104-1107.
[16] 高卉，程云章.血流导向装置与弹簧圈联合治疗巨型颅内动脉瘤的数值模拟研究现状[J].北京生物医学工程，2018，37（4）：419-426.
[17] 洪德全，黄海鹰，杨华，等.介入栓塞术与开颅夹闭术治疗颅内动脉瘤的疗效对比[J].中国现代医生，2018，56（34）：79-82，87.
[18] 吴毅，刘成辉，陈旭，等.血管内介入栓塞和开颅夹闭手术在颅内动脉瘤患者中的应用效果研究[J].中国医药科学，2018，8（7）：213-216.
[19] Orrù E，Roccatagliata L，Cester G，et al. Complications of endovascular treatment of cerebral aneurysms [J]. Eur J Radiol，2013，82（10）：1653-1658.
[20] Yonaha H，Hyodo A，Inaji T，et al. Thromboembolic events associated with coil protrusion into parent arteries after GDC treatment [J]. Interv Neuroradiol，2006，12（Suppl 1）：105-111.
[21] Edwards NJ，Jones WH，Sanzgiri A，et al. Antiplatelet therapy for the prevention of peri-coiling thrombo embolism in high-risk patients with ruptured intracranial aneurysms [J]. J Neurosurg，2017，127（6）：1326-1332.
[22] Adeeb N，Griessenauer CJ，Moore JM，et al. Ischemic stroke after treatment of intraprocedural thrombosis during stent-assisted coiling and flow diversion [J]. Stroke，2017，48（4）：1098-1100.
[23] 姚长青，刘兵，刘志永，等.右美托咪定对颅内动脉瘤手术患者脑血流代谢及脑保护的影响[J].中华肿瘤防治杂志，2017，11（7）：1-3.
[24] 王旭，陈锋，周达全，等.早期颅内动脉瘤夹闭术对颅内动脉瘤患者术后血清炎性因子水平变化及并发症发生率的影响[J].河北医学，2019，25（2）：208-211.
[25] 唐海双，贺晓武，左乔，等.支架辅助弹簧圈栓塞治疗急性期颅内破裂动脉瘤的围手术期危险因素分析[J].第二军医大学学报，2019，40（2）：117-124.
[26] 王贵成，管艳，盛大卫，等.不同靶控浓度右美托咪定对颅内动脉瘤患者脑氧代谢影响研究[J].现代中西医结合杂志，2017，26（11）：1238-1240.